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Full text of "National Conference on Cultural Competence and Women's Health Curricula in Medical Education"

U.S. Public Health Service 



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Offlcl of Minority Health & 
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National Conferencejon 

Cultural Competence & 

Women's Health Currftula 

ih Medical Education 



October 26-28, 1995 
1 Washington, Washington, D.C. 



Mi-H(^J)25^ 



FIRST NATIONAL CONFERENCE 



ON 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA 



IN MEDICAL EDUCATION 

Washington, D.C. 
October 26-28, 1995 



Office of I'^ylinority Health 

Resource Centsr 

PO Sox 37337 

Washington, DC 20013-7337 



Dear Colleague: 

The U.S. Public Health Service's Office of Minority Health and the Office on Women's 
Health, are proud to provide the Conference participants with a copy of this Abstract Book. 

This Abstract Book is a compilation of the sumissions received by our Offices. The 
response to our call for abstracts was impressive. The abstracts contained in this 
monograph incorporate current knowledge regarding medical education curricula in cultural 
competence and women's health across the country. 

The abstracts received are organized within three categories, each including undergraduate, 
graduate and postgraduate levels of medical education: 

■ Women's Health Curricula, 

■ Cultural Competence Curricula, 

■ Cultural Competence and Women's Health Curricula. 

We hope that this material assists you in developing, implementing, or enhancing your 
efforts to improve medical education training as we enter the 21st century. 



Susan J. Blumenthal, M.D., M.P.A. 
Deputy Assistant Secretary for Health 

(Women's Health) 

Assistant Surgeon General 



Clay E. Simpson, Jr., Ph.D. 
Deputy Assistant Secretary 
for Minority Health 



WOMEN'S HEALTH CURRICULA 



Presenter: Ralph ANDERSON, M.D. 

Title: The Evolving Role of the OB/GYN as a Primary Care Physician for Women 

Affiliation: John Peter Smith Hospital 

Telephone: 817-927-1065 FAX: 817-927-1 162 

City: Fort Worth 

State: Texas 

Presenter: Jay BACHICHA, M.D. 

Title: Primary Care for Women: Education in an Era of Reform 

Affiliation: Northwestern University, Medical School 

Telephone: 312-266-5954 FAX: 31 2-266-61 14 

City: Chicago 

State: Illinois 



Page 
1 



Presenter: Robert Paul CABAJ, M.D. 

Title: Lesbian, Gay and Bisexual Curriculum in Medical Education: 

Homophobia as a Health Hazard 

Affiliation: U of California, School of Medicine 

Telephone: 415-621-5727 FAX: 415-621-5727 

City: San Francisco 

State: California 

Presenter: Berry A. CAMPBELL, M.D. 

Title: Continuity Care Experience in OB/GYN and Pediatrics for Medical Students 

Affiliation: U of Kentucky, College of Medicine 

Telephone: 606-257-2122 FAX: 606-323-1931 

City: Lexington 

State: Kentucky 

Presenter: J. Kenneth COOKE, M.D. 

Title: Integration of Certified Nurse Midwives Into the Faculty of a County 

Hospital OB/GYN Residency 

Affiliation: U of California - San Francisco, School of Medicine 

Telephone: 209-453-5720 FAX: 209-453-8320 

State: Fresno 

State: California 



Presenter: Leah J. DICKSTEIN, M.D. 

Title: Women's Health in Medicine: Core Lectures, Electives and Seminars 

Affiliation: U of Kentucky, College of Medicine 

Telephone: 502-852-6185 FAX: 502-852-8937 

City: Louisville 

State: Kentucky 



WOMEN'S HEALTH CURRICULA 



Presenter: Elizabeth DIMITRIEVICH, M.D. 

Title: Correlation Between Individual Components of the Final Grade in the 

3rd Year Clerkship in OB/GYN 

Affiliation: U of South Dakota, School of Medicine 

Telephone: 605-357-1532 FAX: 605-357-1 528 

City: Sioux Falls 

State: South Dakota 



Page 

7 



Presenter: Catherine DUBE', Ed.D. 

Title: A Curriculum on Communication Skills in Breast and Cervical Cancer Screening 

Affiliation: Brown University Program in Medicine 

Telephone: 401-863-2951 FAX: 401-863-3510 

City: Providence 

State: Rhode Island 

Presenter: Pam Reid DUFFY, Ph.D., R.N. 

Title: Teaching Towards Informed Care of Lesbian Patients 

Affiliation: U of Arizona, College of Medicine 

Telephone: 520-626-2437 FAX: 520-323-2437 

City: Tucson 

State: Arizona 



Presenter: Thomas E. ELKINS, M.D. 

Title: Teaching Ethics in OB/GYN Residency Education: A Model 

Affiliation: Louisiana State University, School of Medicine 

Telephone: 504-568-4852 FAX: 504-568-5140 

City: New Orleans 

State: Louisiana 

Presenter: Marita GRUDZEN, M.H.S. 

Title: Women's Health Clerkship 

AffNiation: Stanford University, School of Medicine 

'Telephone: "415-725-4480 FAX: 41 5-723-9692 

City: Palo Alto 

State: California 

Presenter: Nancy S. HARDT, M.D. 

Title: Task Force on Reproductive Science Expands Horizons 

Affiliation: U of Florida, College of Medicine 

Telephone: 904-395-0238 FAX: 904-395-0437 

City: Gainsville 

State: Florida 



10 



11 



12 



Presenter: William H. HINDLE, M.D. 

Title: Breast Evaluation and Diagnosis within an OB/GYN Department 

Affiliation: U of Southern California, School of Medicine 

Telephone: 213-226-4018 FAX: 213-226-3424 

City: Los Angeles 

State: California 

-iii- 



13 



WOMEN'S HEALTH CURRICULA 



Presenter: Carol S. HODGSON, Ph.D. 

Title: Assessing Training Effectiveness for Health Care Providers 

Affiliation: U of California, UCLA School of Medicine 

Telephone: 310-794-7530 FAX: 310-794-7465 

City: Los Angeles 

State: California 

Presenter: Sandra J. HOFFMAN, M.D. 

Title: Women's Health Track in an Internal Medicine Residency Program in 

a Community Setting 

Affiliation: Michigan State University, College of Human Medicine 

Telephone: 616-337-6357 FAX: 616-337-4234 

City: Kalamazoo 

State: Michigan 

Presenter: Thomas A. JOHNSON, M.D. 

Title: A Maternal Child Health Clerkship: Developing an Understanding of 

the Patient/Physician Relationship 

Affiliation: U of Massachusetts Medical School 

Telephone: 508-856-3649 FAX: 508-856-5016 

City: Worcester 

State: Massachusetts 

Presenter: Kenneth R. KELLNER, M.D., Ph.D. 

Title: A Program to Promote Medical Students Appreciation of the Nurse's 

Role in Labor and Delivery 

Affiliation: U of Florida, College of Medicine 

Telephone: 904-392-2894 FAX: 904-392-2808 

City: Gainsville 

State: Florida 

Presenter: Rebecca KNIGHT, M.D. 

title: Teaching Women's Health in the Outpatient Setting 

Affiliation: U of Illinois, College of Medicine 

Telephone: 309-655-2000 FAX: 309-655-6879 

City: Peoria 

State: Illinois 

Presenter: Mitzi KROCKOVER, M.D. 

Title: Women's Health Curriculum Using a Multidisciplinary Approach 

Affiliation: U of California, UCLA School of Medicine 

Telephone: 310-794-9830 FAX: 310-794-9824 

City: Los Angeles 

State: California 



Page 
14 



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-IV- 



WOMEN'S HEALTH CURRICULA 



Presenter: Melodee LASKY, M.D. 

Title: Primary Care Training for OB/GYN Residents: A Collaborative Project 

Affiliation: U of Medicine and Dentistry of NJ, New Jersey Medical School 

Telephone: 908-685-2899 FAX: 908-704-0083 

City: Sommerville 

State: New Jersey 

Presenter: June LAVALLEUR, M.D. 

Title: A National Survey of Education and Research Regarding Mature 

Women's Health in OB/GYN Residency Programs 

Affiliation: U of Minnesota, Medical School 

Telephone: 612-625-5979 FAX: 61 2-626-0665 

City: Minneapolis 

State: Minnesota 



Page 
20 



21 



Presenter: Sandra LEVISON, M.D. 

Title: Implementing an Integrated Women's Health Curriculum 

Affiliation: Medical College of Pennsylvania & Hahnemann U School of Medicine 

Telephone: 215-842-6426 FAX: 215-843-0253 

City: Philadelphia 

State: Pennsylvania 

Presenter: Diane MAGRANE, M.D. 

Title: APGO Quiz: A learning System for Students of Women's Health Care 

Affiliation: U of Vermont, College of Medicine 

Office of Medical Education 

Telephone: 802-656-0722 FAX: 802-656-8577 

City: Burlington 

State: Vermont 



22 



23 



Presenter: Rebecca P. MCALISTER, M.D. 

Title: Utilization of Advanced Practice Nurses in Ambulatory OB/GYN Clinics 

'Afflliatiori: "Washington U, School of Medicine 

Telephone: 314-362-4211 FAX: 314-362-0049 

City: St. Louis 

State: Washington 

Presenter: Kathleen MCINTYRE-SELTMAN, M.D. 

Title: Implementing Curricular Objectives in Women's Health 

Affiliation: Association of Professors of OB/GYN 

Telephone: 412-641-1440 FAX: 41 2-641-1 133 

City: Pittsburgh 

State: Pennsylvania 



24 



25 



WOMEN'S HEALTH CURRICULA 



Presenter: Ann W. MOULTON, M.D. 

Title: Women's Health Fellowship at Brown University 

Affiliation: Brown University Program in Medicine 

Telephone: 401-444-8472 FAX: 401-444-4730 

City: Providence 

State: Rhode Island 

Presenter: Linda NEIMAN, Ph.D. 

Title: Evaluating a Problem-Based Women's Health Curriculum 

Affiliation: Medical College of Pennsylvania 

Telephone: 215-991-8518 FAX: 215-843-6794 

City: Philadelphia 

State: Pennsylvania 

Presenter: JoDean NICOLETTE, MS IV 

Title: Women's Health Curriculum at Stanford 

Affiliation: Stanford University, School of Medicine 

Telephone: 415-321-5591 FAX: 

City: Stanford 

State: California 



Page 
26 



27 



28 



Presenter: James J. NOCON, M.D. 

Title: Detection of Domestic Violence in Women Presenting to a County Hospital 

Emergency Room 

Affiliation: Indiana University, School of Medicine 

Telephone: 317-630-6280 FAX: 317-630-6524 

City: Indianapolis 

State: Indiana 



29 



Presenter: James J. NOCON, M.D. 

Title: Gender Reconciliation in the Art of Healing 

Pre'senter: "James J. NOCON, M.D. 

Title: Using Problem-Based Learning to Detect and Change Gender Related 

Biases and Sexual Attitudes 



30 



31 



Presenter: James J. NOCON, M.D. 

Title: Using Problem-Based Learning to Teach the Detection and 
Management of Domestic Violence 

Presenter: Katherine A. O'HANLAN, M.D. 

Title: Homophobia Obstructs the Provision of Quality Care for Lesbians 

Affiliation: Stanford University, School of Medicine 

Telephone: 415-723-8585 FAX: 41 5-723-7737 

City: Stanford 

State: California 



32 



33 



-VI- 



WOMEN'S HEALTH CURRICULA 



Presenter: Sharon O'LEARY, M.D. 

Title: Nurse-Resident Preceptor Program to Foster Collaborative Working 

Relationship 

Affiliation: William Beaumont Hospital 

Telephone: 313-434-6200 FAX: 31 3-434-7373 

City: Ypsilanti 

State: Michigan 

Presenter: Kelly S. PARSEY, M.D. 

Title: Designing a Primary Care Curriculum for OB/GYN Residents: Results 

of a Needs Assessment 

Affiliation: Duke University, School of Medicine 

Telephone: 919-286-6936 FAX: 91 9-416-5836 

City: Durham 

State: North Carolina 

Presenter: Kathryn E. PEEK, Ph.D. 

Title: Program in Female Clinical Anatomy: A Model for Incorporating 

Women's Health into the Basic Sciences 

Affiliation: U of Texas, Medical School 

Telephone: 713-745-2143 FAX: 713-792-5795 

City: Houston 

State: Texas 

Presenter: Sharon T. PHELAN, M.D. 

Title: Impact of Clerkship Requirement on Use of CAI 

Affiliation: U of Alabama, School of Medicine 

Telephone: 205-934-7872 FAX: 205-934-2258 

City: Birmingham 

State: Alabama 

Presenter: Sharon T. PHELAN, M.D. 

title: Timing of Pelvic Exam Instruction During Medical School 

Affiliation U of Alabama, School of Medicine 

Telephone: 205-934-7872 FAX: 205-934-2258 

City: Birmingham 

State: Alabama 

Presenter: Janet PREGLER, M.D. 

Title: Developing and Implementing a Women's Health Curriculum from a 

Generalist Perspective 

Affiliation: U of California, UCLA School of Medicine 

Telephone: 310-794-9830 FAX: 310-794-9824 

City: Los Angeles 

State: California 



Page 
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36 



37 



38 



39 



-VII- 



WOMEN'S HEALTH CURRICULA 



Page 



Presenter: Michelle M. ROBERTS, M.D. 

Title: The Women's Health Track: A Model for Training Internal Medicine Residents 

Affiliation: University of Pittsburgh, School of Medicine 

Telephone: 412-648-9770 FAX: 41 2-648-7047 

City: Pittsburgh 

State: Pennsylvania 



40 



Presenter: Patricia A. ROBERTSON, M.D. 

Title: Development and Implementation of a Women's Health Curriculum 

for Medical Students 

Affiliation: U of California, School of Medicine 

Telephone: 415-476-1824 FAX: 41 5-476-181 1 

City: San Francisco 

State: California 



41 



Presenter: Patricia A. ROBERTSON, M.D. 

Title: Student Evaluation of an Assigned Day in an Abortion Clinic in the 

Junior Clerkship in OB/GYN 



42 



Presenter: Elmar P. SAKALA, M.D., M.P.H. 

Title: Medical Student Gender & Personality Type as Factors in Clinical 

Evaluations on a Junior OB/GYN Rotation 

Affiliation: Loma Linda University, School of Medicine 

Telephone: 909-824-4762 FAX: 909-824-4767 

City: Loma Linda 

State: California 



43 



Presenter: Stuart J. SLAVIN, M.D. 

Title: Doctoring: A Focus on Women's Health 

Affiliation: U of California, UCLA School of medicine 

Telephone: 310-206-8750 FAX: 310-825-6394 

City: Los Angeles 

State: "California 



44 



Presenter: Kathleen M. THOMSEN, M.D., M.P.H. 

Title: Primary Care Women's Health Fellowship 

Affiliation: U of Medicine & Dentistry of NJ - Robert Wood Johnson Medical School 

Telephone: 908-235-7670 FAX: 908-246-0884 

City: New Brunswick 

State: New Jersey 



45 



-VIM- 



Page 
46 



47 



WOMEN'S HEALTH CURRICULA 



Presenter: Lila A. WALLIS, M.D., FACP 

Title: Painless and Competent Pelvic Examination in Medical Education & CME 

Affiliation: Cornell University, Medical College 

Telephone: 212-737-4444 FAX: 21 2-737-1 1 85 

City: New York 

State: New York 

Presenter: Carole WARSHAW, M.D. 

Title: Advocacy-Based Medical School Elective on Domestic Violence 

Affiliation: Cook County Hospital 

Telephone: 31 2-433-2390 FAX: 31 2-433-2391 

City: Chicago 

State: Illinois 



Presenter: Michael WILKES, M.D., M.P.H. 48 

Title: Doctoring: An Innovative Curriculum Teaching Medical Students About Domestic 

Violence 

Affiliation: U of California, UCLA School of Medicine 

Telephone: 310-206-3708 FAX: 310-206-0719 

City: Los Angeles 

State: California 



Presenter: William W. YOUNG, M.D. 

Title: The Home Birth Case - Health, Society and the Physician 

Affiliation: Dartmouth Medical School 

Telephone: 603-650-5000 FAX: 603-650-5458 

City: Lebanon 

State: New Hampshire 



49 



-IX- 



CULTURAL COMPETENCE CURRICULA 



Presenter: Liza CARIAGA-LO, Ed.D. 

Title: The Culture and Society Seminar for Undergraduate Medical Students 

Affiliation: Bowman Gray School of Medicine of Wake Forest University 

Telephone: 910-716-5686 FAX:910-71 6-5807 

City: Winston-Salem 

State: North Carolina 



Page 
50 



Listening to Patients and Ourselves 



Presenter: Patricia N. CARVER, Ph.D. 

Title: Confluence of Cultures in Medical Education: 

Affiliation: U of Medicine and Dentistry of New Jersey 

Telephone: 908-235-7662 FAX: 908-246-8084 

City: New Brunswick 

State: New Jersey 



Presenter: Denice CORA-Bramble, M.D., F.A.A.P. 

Title: Cultural Competence Curriculum for Health Care Providers: Hispanic Module 

Affiliation: George Washington U, School of Medicine 

Telephone: 202-917-2991 FAX: 301-390-1032 

City: Washington 

State: District of Columbia 



51 



52 



Presenter: K.A. CULHANE-Pera, M.D., M.A. 

Title: Intercultural Family Medicine Curriculum 

Affiliation: St. Paul Ramsey Medical Center 

Telephone: 612-221-3540 FAX: 612-222-1816 

City: St. Paul 

State: Minnesota 



53 



Presenter: Catherine DUBE', Ed.D. 

Title: Race, Culture and Ethnicity: Addressing Alcohol and Other Drug Problems 

Affiliation: Brown University Program in Medicine 

Telephone: 401-863-2951 FAX: 401-863-3510 

City: Providence 

State: Rhode Island 



54 



Presenter: Jamal FAWAZ, M.D. 

Title: Cultural Diversity Conferences for Psychiatry Residents 

Affiliation: U of Maryland, School of Medicine 

Telephone: 410-328-6018 FAX: 410-328-6391 

City: Baltimore 

State: Maryland 

Presenter: Mona FOUAD, M.D., M.P.H. 

Title: Physician Training Program to Enhance Adherence Among Underserved 

Minority Women 

Affiliation: U of Alabama, School of Medicine 

Telephone: 205-934-2125 FAX: 205-934-7959 

City: Birmingham 

State: Alabama 

-X- 



55 



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CULTURAL COMPETENCE CURRICULA 



Presenter: Ronald D. GARCIA, Ph.D. 

Title: Ethnicity and Medicine: Teaching Cultural Competency 

Affiliation: Stanford University, School of Medicine 

Telephone: 415-725-0403 FAX: 41 5-725-5538 

City: Palo Alto 

State: California 

Presenter: Deborah GOULD, M.D. 

Title: Cultural Competence in a Pediatric Clinic in a Managed Care Environment 

Affiliation: Kaiser Permanente Medical Center 

Telephone: 510-987-3016 FAX: 510-873-5142 

City: Oakland 

State: California 

Presenter: Marvin L. HAGE, M.D. 

Title: Teaching Cross-Cultural Medicine 

Affiliation: Duke University Medical School 

Telephone: 919-681-5220 FAX: 919-681-7861 

City: Durham 

State: North Carolina 

Presenter: Joseph HAN, M.S. Ill 

Title: Interactive Health Fair 

Affiliation: Medical College of Pennsylvania 

Telephone: 215-576-6221 FAX: 21 5-843-7694 

City: Jenkintown 

State: Pennsylvania 

Presenter: Cynthia HAG, M.D. 

Title: Undergraduate Multicultural Health Care Curriculum at the U. of Wisconsin 

Affiliation: U of Wisconsin, Medical School 

Telephone: 608-263-6549 FAX: 608-263-5813 

City: Madison 

State: Wisconsin 

Presenter: Christina HARLAN, B.S.N., M.A. 

Title: Cultural Competency in Public Health Practice 

Affiliation: U of North Carolina, School of Public Health 

Telephone: 919-966-9877 FAX: 919-966-2921 

City: Chapel Hill 

State: North Carolina 

Presenter: Janice HERBERT-Carter, M.D., M.G.A. 

Title: Teaching Cultural Competence - The Painless Way 

Affiliation: Morehouse School of Medicine 

Telephone: 404-752-1897 FAX: 404-752-1064 

City: Atlanta 

State: Morehouse 



Page 
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-XI- 



CULTURAL COMPETENCE CURRICULA 



Presenter: Gerald HILL, M.D. 

Title: The Indian Health Pathway and Native American Center of Excellence 

Affiliation: U of Minnesota, Medical School 

Telephone: 612-626-2075 FAX: 61 2-824-0820 

City: Minneapolis 

State: Minnesota 

Presenter: Walt HOLLOW, M.D., M.S. 

Title: A Medical School Curriculum in American Indian Health 

Affiliation: U of Washington, School of Medicine 
Native American Center for Excellence 

Telephone: 206-685-2489 FAX: 206-543-9063 

City: Seattle 

State: Washington 

Presenter: Walt HOLLOW, M.D., M.S. 

Title: Traditional Indian Medicine: How Does it Relate to Modern Western Medicine? 

Presenter: Robert K. KAMEI, M.D. 

Title: Teaching Pediatric Residents the Impact of Cultural Diversity on the 

Medical Encounter 

Affiliation: U of California, School of Medicine 

Telephone: 415-476-0987 FAX: 415-476-4009 

City: San Francisco 

State: California 

Presenter: Sophia LEE 

Title: A Model for Teaching Bias-Free Communication Skills 

Affiliation: Medical College of Pennsylvania & Hahnemann U School of Medicine 

Telephone: 215-842-6426 FAX: 215-843-0253 

City: Philadelphia 

State: Pennsylvania 

Presenter: B U.K. LI, M.D. 

Title: Teaching Cultural Competency to First-Year Medical Students by an 

Experimental Approach 

Affiliation: Ohio State University, College of Medicine 

Telephone: 614-722-3450 FAX: 614-722-3454 

City: Columbus 

State: Ohio 



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-XII- 



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CULTURAL COMPETENCE CURRICULA 



Page 



Presenter: Robert C. LIKE, M.D., M.S. 

Title: A Multicultural Community-Oriented Primary Care Fellowship Program for Family 

Physicians 

Affiliation: U of Medicine and Dentistry of NJ, Robert Wood Johnson Medical School 

Telephone: 908-235-7662 FAX: 908-246-8084 

City: New Brunswick 

State: New Jersey 



70 



Presenter: Doric LITTLE, Ed.D. 

Title: Native Hawaiian Culture Across the Curriculum 

Affiliation: U of Hawaii at Manoa, John A. Burns School of Medicine 

Telephone: 808-956-6586 FAX: 808-956-4461 

City: Honolulu 

State: Hawaii 



71 



Presenter: Barbara MARQUEZ, M.P.H. 

Title: Beyond Rhetoric: Cultural Competency into Practice 

Affiliation: California Dept. of Health Services, Office of Multicultural Health 

Telephone: 916-322-6868 FAX: 916-324-7763 

City: Sacramento 

State: California 



73 



Presenter: Martha A. MEDRANO, M.D. 

Title: An Introduction to Culture and Cross-Cultural Communication in the Medical 

Encounter 

Affiliation: U of Texas Medical School, Dept. of Psychiatry 

Telephone: 210-567-5480 FAX: 210-567-5381 

City: San Antonio 

State: Texas 



74 



Presenter: Ana E. NUNEZ, M.D. 

Title: Clinical Preceptor Training for Students in a Longitudinal Cross-Cultural Program 

Affiliation: Medical College of Pennsylvania & Hahnemann U School of Medicine 

Telephone: 215-762-7296 FAX: 21 5-762-8654 

City: Philadelphia 

State: Pennsylvania 



75 



Presenter: Ana E. NUNEZ, M.D. 

Title: Looking Within to See the Outside Better: A Model for Cross-Cultural 

Effectiveness Education 



76 



Presenter: Sharyne SHIU-THORNTON 

Title: Cultural Competency: Applications for Public Health Practice 

Affiliation: University of Washington, School of Medicine 

Telephone: 206-616-2940 FAX: 206-543-3964 

City: Seattle 

State: Washington 



77 



-XIII- 



CULTURAL COMPETENCE CURRICULA 



Page 



Presenter: Melanie TERVALON, M.D., M.P.H. 

Title: The Multicultural Curriculum Project 1994-95 

Affiliation: Children's Hospital 

Telephone: 510-428-3331 FAX: 510-428-3859 

City: Oakland 

State: California 



78 



Presenter: A. Belinda TOWNS, M.D., M.P.H. 

Title: A Third & Fourth Year Primary Care Curriculum and Diversity 

Affiliation: U of California - UCLA School of Medicine, Charles R. Drew 

Telephone: 213-563-4843 FAX: 213-563-5938 

City: Los Angeles 

State: California 



79 



-XIV- 



WOMEN'S HEALTH 

and 

CULTURAL COMPETENCE CURRICULA 



Presenter: Dyanne D. AFFONSO, Ph.D., F.A.A.N. 

Title: Cultural Diversity and Preventative Health Care for Women During 

Pregnancy 

Affiliation: Emory University, School of Nursing 

Telephone: 404-727-7976 FAX: 404-727-4645 

City: Atlanta 

State: Georgia 

Presenter: Yamila AZIZE Vargas, Ph.D. 

Title: Latina Issues and Perspectives for a Gender-Balanced Curricula in 

Medical Education 

Affiliation: U of Puerto Rico, School of Medicine 

Telephone: 809-738-7863 809-738-4218 FAX: 809-738-4218 

City: Cayey 

State: Puerto Rico 



Page 
80 



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81 



Presenter: Flora BRYANT, Ph.D. 

Title: Domestic Violence Curriculum 

Affiliation: Howard University, College of Medicine, Dept. of Emergency Medicine 

Telephone: 202-865-1121 FAX: 202-865-4492 

City: Washington 

State: District of Columbia 



83 



Presenter: Pamela CHARNEY, M.D. 

Title: Coronary Artery Disease (CAD) and Gender: Prevention, Diagnosis 

and Management 

Affiliation: Albert Einstein College of Medicine of Yeshiva University 

Telephone: 71 8-91 8-7463 FAX: 71 8-91 8-7701 

City: New York 

•State: -New York ' 



84 



Presenter: Molly S. CHATTERJEE, M.D. 

Title: Cultural Competence and Women's Health Curriculum in Medical Education 

Affiliation: Meharry Medical College, School of Medicine 

Telephone: 61 5-327-6284 FAX: 61 5-327-6296 

City: Nashville 

State: Tennessee 



85 



Presenter: Helen L. COONS, Ph.D. 

Title: Optimizing Health Outcomes in Ethnically Diverse Women with 

HIV/AIDS: CME for Primary Care Physicians 

Affiliation: Medical College of Pennsylvania 

Telephone: 21 5-762-761 6 FAX: 21 5-762-8654 

City: Philadelphia 

State: Pennsylvania 



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-XV- 



WOMEN'S HEALTH 

and 

CULTURAL COMPETENCE CURRICULA 



Presenter: Dyanne D. AFFONSO, Ph.D., F.A.A.N. 

Title: Cultural Diversity and Preventative Health Care for Women During 

Pregnancy 

Affiliation: Ennory University, School of Nursing 

Telephone: 404-727-7976 FAX: 404-727-4645 

City: Atlanta 

State: Georgia 

Presenter: Yamila AZIZE Vargas, Ph.D. 

Title: Latina Issues and Perspectives for a Gender-Balanced Curricula in 

Medical Education 

Affiliation: U of Puerto Rico, School of Medicine 

Telephone: 809-738-7863 809-738-4218 FAX: 809-738-4218 

City: Cayey 

State: Puerto Rico 



Page 
80 



81 



Presenter: Flora BRYANT, Ph.D. 

Title: Domestic Violence Curriculum 

Affiliation: Howard University, College of Medicine, Dept. of Emergency Medicine 

Telephone: 202-865-1121 FAX: 202-865-4492 

City: Washington 

State: District of Columbia 



83 



Presenter: Pamela CHARNEY, M.D. 

Title: Coronary Artery Disease (CAD) and Gender: Prevention, Diagnosis 

and Management 
Affiliation: Albert Einstein College of Medicine of Yeshiva University 

Telephone: 718-918-7463 FAX: 718-918-7701 

City: New York 

Stale: "New York ■ 



84 



Presenter: Molly S. CHATTERJEE, M.D. 

Title: Cultural Competence and Women's Health Curriculum in Medical Education 

Affiliation: Meharry Medical College, School of Medicine 

Telephone: 615-327-6284 FAX: 615-327-6296 

City: Nashville 

State: Tennessee 



85 



Presenter: Helen L. COONS, Ph.D. 

Title: Optimizing Health Outcomes in Ethnically Diverse Women with 

HIV/AIDS: CME for Primary Care Physicians 

Affiliation: Medical College of Pennsylvania 

Telephone: 215-762-7616 FAX: 21 5-762-8654 

City: Philadelphia 

State: Pennsylvania 



86 



-XV- 



Presenter: 

Title: 

Affiliation: 

Telephone: 

City: 

State: 



WOMEN'S HEALTH 

and 

CULTURAL COMPETENCE CURRICULA 



Zylphia FORD, M.P.H. 

Reframing Women's Health: An Itensive Multidiscipiinary Institute 

U. of Illinois, College of Medicine 

312-41 3-1 924 FAX: 312-41 3-7423 

Chicago 

Illinois 



Page 
87 



Presenter: Roberta GOLDMAN, Ph.D. 

Title: Cultural Issues in Communication About Breast & Cervical Cancer 

Screening 

Affiliation: Brown University Program in Medicine 

Telephone: 401-729-2924 FAX: 401-729-2923 

City: Providence 

State: Rhode Island 



88 



Presenter: Roberta GOLDMAN, Ph.D. 

Title: Teaching the Cultural Dimension of Maternal and Child Health in a 
Family Medicine Residency Program 

Presenter: Maria Elia GOMEZ-Murphy, M.A. 

Title: Innovative Strategies for Health Care: The Promotora 

Affiliation: Mariposa Community Health Foundation 

Telephone: 602-762-2153 FAX: 

City: Nogales 

State: Arizona 



89 



90 



Presenter: Lesley R. LEVINE, M.D. 

Title: Resident Education in Diversity Awareness in a Managed Care Setting 

Affiliation: Kaiser Permanente Medical Center 

'Telephone: "510-596-6361 FAX: 510-596-7458 

City: Oakland 

State: California 



91 



Presenter: Lois A. MONTEIRO, Ph.D. 

Title: Faculty Preparation for Women's Health Curricula Development 

Affiliation: Brown University Program in Medicine 

Telephone: 401-863-1629 FAX: 401-863-3713 

City: Providence 

State: Rhode Island 



92 



-XVI- 



WOMEN'S HEALTH 

and 

CULTURAL COMPETENCE CURRICULA 



Presenter: Ana E. NUNEZ, M.D. 

Title: Sociocultural Aspects of Women's Health in Undergraduate Medical 

Education 

Affiliation: Medical College of Pennsylvania & Hahnemann U School of Medicine 

Telephone: 215-762-7616 FAX: 215-762-8654 

City: Philadelphia 

State: Pennsylvania 

Presenter: Katherine SHERIF, M.D. 

Title: Teaching Health Concerns of Arab and Muslim Women 

Affiliation: Medical College of Pennsylvania & Hahnemann U School of Medicine 

Telephone: 215-842-7390 FAX: 215-843-0253 

City: Philadelphia 

State: Pennsylvania 

Presenter: Louis G. STEELE, M.D. 

Title: Cultural Competence and Provisions of Women's Health in American 

Indian Communities 

Affiliation: U of Arizona 

Telephone: 520-295-2479 FAX: 520-295-2602 

City: Tucosn 

State: Arizona 



Page 
93 



94 



95 



Presenter: John TAKAYAMA, M.D., M.P.H. 

Title: Training Residents in Violence Prevention & Cultural Competence 

Affiliation: U of California, School of Medicine 

Telephone: 415-476-5763 FAX: 41 5-476-8130 

City: San Francisco 

State: California 



96 



-XVII- 



CULTURAL COMPETEHCE AND WOMEN'S HEALTH CURWCULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Titlb: The Evolvlne Role of the Obstetrician & Gynecologist as a Primary Ca re 

Physician for Women 
Praganter: Ralph Anderson, M.D. Title: Chairn^an, Dept. of Obstetrics & Gynecology 

Si"? 927 1065 sTt 927-1162 

AfflliatJon; J ohn Peter Snith Hospita lrflt^phone; I ) FAX: f I _. 

(f/iedic»i $choo4;F«s(48ncy Program) 



Addresa: '-500 South Main Street, Fort Worth. Texas, 76104 ■ 

City Zip Cede 

Compietfng the Abstract Submission Form 

• AH text shoiid be tvp«l witNn th» perimeTarc of lh« box shown. Forrta no 9m%\itr than 10 poJnta shouid be used. 

• Organize the text o. ihe abstract m fotiow«; (1) objectives of tt» cunicaivmi (2) cumcuiwn dMcrtplJon; 
(3> probtetrs ancounterad: and f^l results. 



r 



L 



General obstetricians and gynecologists have traditionally functioned as the primary care 
physician for women with obstetrical and gynecologic problems. With the evolution of managed 
care this role has been expanded to that of providing primary health care to women. The 
American College of Obstetricians and Gynecologists (A.C.O.G.) and the Council on Resident 
Education in Obstetrics and Gynecology (CREOG) have altered the educational program for 
obstetricians and gynecologists as primary care physicians for women. Considerable evidence 
exists that reinforces the role of an obstetrician/gynecologist as a PCP. Fifty-six percent of 
women aged 15-44 have an obstetrician/gynecologist as their PCP; 85% of maternity cases are 
looked after by obstetricians and gynecologists. Women overwhelmingly prefer obstetricians and 
gynecologists in the treatment of pregnancy, postpartum care and postmenopausal care. The Fort 
Worth Hospitals Program in obstetrics and gynecology has developed a model of primary care 
education that involves a close liaison between hospitals, the public health department, and other 
primary care providers, (family physicians, internal medicine doctors and physician 
extenders). It recognizes the A.C.O.G. definition of a PCP, identifies patients with common and 
acute illness^BG that should be managed by a PCP for women and defines those patients with acute 
or chronic conditions that should be transferred to other PCPs. The model recognizes the concept 
of a generic PCP that consists of family physicians, internal medicine doctors, obstetricians and 
gynecologists and pediatricians and acknowledges the fact that no one group of doctors operates as 
PCP for all pdtients. This model involves a generalist exposure in the first year, a team concept 
for the delivery of health care in second and fourth year, and a rotation with a family physician at 
the third year. The ACGME has outlined an educational program for PCPs whose cfategories include 
care of the population, care of patients in multiple settings, comprehensive preventive care, 
treatment of common acute illnesses, treatment of common chronic conditions, treatment of 
common ch.onic behavioral problems and other training for the generalist physician. The Fort 
Worth Hospitals Program accomplishes PCP teaching in 92% of these categories. A full 
discussion of this primary care model will be conducted to outline the education of the 
obstetrician and gynecologist which allows him/her to practice as a PCP for women. 



Addr«$ .lutmissions to: Elan, Rios. M.D.. M.S.P.W. Telephone: |2C2) 690-5834 

?ci"J" ';:^'^'^'» «"'^- OAS« P^: (202) 690-7172 

2C0 ;odependen<:B Ave., N.W.. Room 730-B 
Wasnirgton, O.C. 202C1 

DEADLINE FOR SUBMISSION: 



CULTURAL COMPSTENCS AWD WOMEN'? HEALTH CURRICULA IN MEDICAL tuvx^Min^™ 



Abstract TitJe: 



ABSTRACT SUBMISSION FORM 

Primarv Care Fo" Wonen: Ed-jcatijn in an Era of Re for: 



Title: 



Presenter: Jav Bachicha MP 

Northwestern University 312-266-5954 

Affiliation: "-i p h j ^ 3 1 S c ^ : ^ Telephone: ( } 

CM8<llcaJ Schooim«»ic<rtcv Program^ 

Address; 333 E . Superi or St. Sjite 464 



Assistant Proi^essor 



31 2-266-51 14 
FAX: I ) 



Chicago, IL 6061 



^ . . ^ *. City Zip Coda 

Comptettng th« Abstract Submrs^fon Fonri 

■ Afl tKrt ihotjti b« typed within Tn« o«nmet€f* of th« box »hown. Fortts no unailv than 1 po*rt» »hodd be us*d 

■ Ofoani» tf^e text of ttw abMnct u foBdwa; HJ oojactwes of th« carTKsjtn; (2) curriaflom <lt«aipdon: 
<3) pfobtems grjccmitwed; «nd 14) r«u<t». 



This presentation describes an innovative program established by the 
Department of Obstetrics and Gynecology at Northwestern University 
Medical School to provide clinical education to third year medical 
students in the area of primary health care for women. The inter- 
disciplinary program unites faculty from various departments -in 
order to provide comprehensive didactic education, learner-centered 
learning experiences, and clinical exposure to students in selected 
primary care topics. 



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i Student response to the curriculum, especially the outpatient 

i experiences, has been overwhelmingly positive. Exit interviews withi 

I them show increased recognition of the importance of women's health 



;jdrus AufainiBfifons :a: Sens Rios. M.O., M.SP.H. 

Offle* on WMn«i'« HMith. OASH 

200 tRd«p«ndcnc« Av«.. N.W , Room 730-8 

W«9hinoton. O.C. 20201 



Tddaphona: 
FAX: 



<202) 690-9B84 
(202) etO-7172 



DEANJNE FOR SUBMISSION: FRIDAY, 3UWC Ofl, 193S 



L 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

suae: Title ^^^f^ ^^ , ^A. <*^ ^(<=Ax^ Cyjj^r^c^\...^^ / Ia^cVu^ ^JJtj^cJn'o-^ ; 

esen'er- (^oVl<V^ PcuJ /^ ^\otv; h/IQ. Title: M^CC^S^ech^ . f >r^ A^^^c U>^H '^^'^^ . 

$#K>v.cfc^ Cou^ fin.^.t.tA^ Telephone: j^^^ ^^> S~^ ^"7 FAX: f'^Sl <^Zf . y^^ ;> 

(Medical School/Besidencv Program) 



frJiation; 



i^CSi^ 



address: 



City Zip Code 



Ipmpleting the Abstract Submission Form 

•At! rex: should De typed w,th,n th^ penrr^ei-rs of the box shown. Ponts r,o irr^jl)*- than 10 Do.nts sr^ould be used 
O^gar^z* the text cf .he abstract as follows: (1) otJj«ctiv«» of th« curnculum; 12) currtculum descnpt.on; 
f31 orobl«nns encountered; and (4) results. 



(\) Objectives : The use oTa curriculum on lesbian, gay. and bisexual issues should accomplish the 
following: a.) Teach basic infomnation about health concerns, both medical and mental, that face lesbians, 
gay men. and biiexuals (LGMB); b.) Teach basic information about sexual orientation and what it is like 
to be lesbian, gay, or bisexual (LGB) in society, including understanding internalized homophobia and 
heterosexism; c.) Explore the personal feeling and attitudes of the students of the curriculum about 
homosexuality in general and about working with LGB patients and colleagues; and d.) Help change 
negative attitudes about LGMB with education and, when possible, direct contact with openly LGB 
faculty. 

(2) Pescript' on: The Gay and Lesbian Medical Association (GLMA) has worked on two important 
documents: a paper on homophobia as a health hazard, and a report on discrimination against LGB 
physicians and medical students. The American Psychiatric Association (APA) has published a curriculum 
on teaching about LGB issues to psychiatric residents. The presenter has just completed editing a textbook 
including a chapter on teaching medical students about LGB concerns. The curriculum presented is a 
combination of all four items, and will focus on: a.) Basic information about sexual orientation, including 
genetics, biology, and cultural and social factors; b.) Basic information about homosexuality, LGMB. and 
transsexuality. including cross-cultural factors, societal heterosexism and homophobia, and the role of 
internalized homophobia in identity formation, developmental steps, and the process of identifying as a 
LGB person (also known as "coming-out"); c.) Specific medical issues relevant to LGMB, including 
breast cancer. OB.GYN issues,- parenting and alternative insemination, mental health issues resulting from 
shame and internalized homophobia, depression, suicidality, substance abuse, violence, and HIV/ AIDS; 
d.) Specific focures on sub-groups of LGMB, including adolescents and youth, the elderly, people of 
color, relationships, families-of-origin and chosen families, parenting by same-sex couples, and bisexual 
marriages; and e.) Exploring possible resistance to presenting a curriculum on LGB issues, a reluctance on 
the part of LGB faculty to be open about their sexual orientation, and ways to help overcome these 
barriers. 

(3^ Problems ; The resistance that society in general has to acknowledging LGMB, and the 
reluctance to accept and understand homosexuality as a normal, though less frequent, expression of human 
sexual and affectionai expression present the greatest obstacles and problems to teaching this material, or 
have information available to students, faculty, and patients. Specific problems and barriers to teaching 
this material and fostering a non-discriminatory approach to LGMB will be discussed. 

(4) Results : An appreciation and understanding of a successful curriculum on LGB issues in 
medicine, and the way sit can be integrated into medical school teaching, will be the results of the 
presentation. A successful teaching model and the results of the GLMA discrimination survey will be 
presented _^ 



vnviii.^ su6mi8»ions to: 6l«n« Aios. M.O., M.S P H. T«*«pftone: (202) 890-5884 

Office on Wom«n •« H««lth. CASH FAX; (202) 690-7172 

1200 lr>deo«f>d«f»c« Ave., I^.W.. Room 730-B 
WMhin^ton, O.C. 20201 

DEADLINE FOR SUBMISSION: FMBAI. JULY 21, 1^5 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Titie. Continuicy Care Experience in Cbstetrics /Gynecology and Pediatrics 

for Medical Students Assistant Professor 
Presenter; Berrv A. Campbell, MP Title; Maternal-Fetal Medicine , 

Affiliation: Univ. of KY Medical Schoo lTelephone: (6061 257.-2122 FAX: ^06) 323rl931 

(MeGicai School/Residency Program) 



i 



Address: 800 Rose Street, Room C-371 Lexington, KY 40536-0084 j 

City Zip Code Ml 

Completing the Abstract Submission Form 

■ All text snould be typed within the pefimeters of the box shown. Pants no smaller than 10 points should be used. I 

■ Organize the text of the aostract as follows: (I) objectives of the curriculum; (2) curriculum description; fj^ 
(3l problems encountered: and (4) results. 



Continuit) Care E.xperience in Obstetrics/Gynecology and Pediatrics for .Medical Students . 

B. Campbell. S. Woods. D. Grigsb\. S. Tipton 
Universit\ of Kentuck\ College of Medicine. Lexiniiton. KY' 

Objectives: To develop a continuity care experience for medical students which would allow the students exposure to an on going 
relationship with patients and provide a simulation of private practice. . • 

Description: The departments of Obstetrics and Gynecology and Pediatrics at the Universit\ of Kentuck\ College of Medicin* 
have restructured their core curriculum for the third year into a combined course ( 1 6 week rotation) that includes a continuitv care 
clinic experience. This clinic experience involves teams of students who are assigned to follow patients during pregnancyl 
deliven.. and follow up care of the mother and child. At the beginning of each rotation, every student is assigned two pregnanP. 
patients from the Young Parents Program. The students are given beepers which are used for communication between thejj 
students and the clinic staff and between the students and their patients. The students are notified when their patients arrive fo* 
prenatal visits and the patients may call their student doctor with any questions they may have during the antepartum period| 
When a patient presents in labor, the student is called to care for and deliver the patient under the direct supervision of the resident!! 
or attending on call. The student then follows the mother and infant through their six week postpanum visit. At the completion o*'" 
the rotation, students and patients complete evaluation forms focusing on their perception of the overall experience. L 

Because of the overwhelmingly positive response, we have decided to extend the continuity care experience for mother and child 
throughout the students' third and fourth years of medical school. At the beginning of the third. year the continuity card 
experience will be explained to the entire class of 96 medical students. Medical students will then be encouraged to considel 
volunteering to be a_part of this project. During the first year beginning July 1995, 10 volunteers will pilot the initial project. I 
Each student will be assigned two patients which they will follow during their prenatal, intrapanum, and postpartum care. L, 
addition the students will continue to follow the mother and child for gynecologic and pediatric care on a routine and emergen^ 
basis during the remainder of their medical school training. 

Problems: Coordination of schedules was initially difficult but as we became more experienced, these problems have beer! 
resolved. Most other difficulties were logistical in nature and have responded to fine adjustments throughout the rotation. 

Results: Evaluations completed by students and patients during the first two years of this experience have been overwhelmingl\ 
positive. The most commonly voiced benefits include development of patient physician relationship, simulation of privat^_ 
practice, and improved teaching. The most common negative comments were on call requirements and disruption of the students' 
dailv schedule. 



■Addre'-.s fwt'-isso-^s to Elena Rios, M.D . M.S.P H Telephone (2021 690-5884 

Otr.ct on Women's Health. OASH FAX. (202) 690-7 172 

2CC inoeDenden<:e Awe.. N.W., Roofn 730-S 
Wssr-.mgton, D C 202 01 



DEADLINE FOR SUBMISSION: FRIDAY, ,1995 / 

July 21, 4 I 



CULTURAL COMPETENCS AND WOMSN'r HEALTH CURRICULA Oi MBJICAL kUUVA.»u« 

ABSTRACT SUBMISSION FORM 

Integratiion of Certified N'orse :iidwives Into the Facalty of a County 
ibivact Titl«: ilospital 0BA7/N Reside n c/ P^cc.y^rr, 

J. Kennerh Cooke, n.D. Chairman, IDepartment of OB/GYN 

3rasamef : Desi^ee A. McCloskev, C.N.M. Title: Director. Nur^e 'llr^'--'" '^^'^^ ^^ 

Affiliation: UC-San Francisco TdltphOfie: g09< 453^-5720 FAX: <209 45g 8320 

(MMleai Sehooi/ft«ild<ney Rreoraml 

^^. 445 South Cedar Avenue Fresno CA 93702 



City ZpCodt 

CompMnv tha Abstraet SubmittiQn Form 

■ AS tmt iheutf bi tvptd witHn tne etflmfren of tha box shown. Pflim m tmtOv tten 10 pd^mt thduW b« uMtf. 

■ Oisarim ifM tfxt of the itttrtct u foitew*: (1) 9tijiwe6^m of ihi curtteUurm (21 eurrtBUlum dwatpttan: 

(3) prebiams •ncwmarad; and W foutti. | 



rNTEGRAlION OF CERTIFIED NURSE MID wTvES iN'iO THE f ACUL'i Y OF A 
COUNTY HOSPITAL OB/GYN RESIDENCY PROGRAM; D. McCloskev. J. Cooke. 
University of California. San Francisco/Valley Medical Center, Fresno. CA 93702. 

Supervision of third and fourth year medical students. OB/GYN. Family Practice, and 
Transitional interns, on a busy county hospital obstetrical service can be very difficult when 
much of the responsibility is delegated to junior OB residents. In 1988 we began a program in 
which a Certified Nurse Midwife (CNM) was hired to assist the housestaff in the supervision of 
normal labor and spontaneous vaginal delivery during regular daytime hours. Currently, we hav( 
24 hour coverage on Labor and Delivery by CNMs in addition to partial staffing the prenatal 
clinics. All hold clinical faculty positions from the University of California, San Francisco. The 
CNMs manage the majority of the low risk laboring patients with the medical students, under 
supervision, and consultation with resident and faculty staff. They participate in curriculum 
development and present a five lecture series that includes: prenatal care, normal labor and 
delivery, episiotomy repair, normal postpartum care, and clinical pelvimetry. The lecture series 
addresses the academic issues with an emphasis on cultural and gender specific needs of women 
-in our population. This has resulted in more personalized patient care and better one-on-one 
instruction for the students. The "service obligation'' for the housestaff has been greatly reduced, 
allowing them more time to care for high risk patients. The integration of housestaff. physician 
faculty, and CNM faculty has been highly accepted and to the mutual benefit of all. 



I 

L 



UdTMt ■ubml«»lOM to: Sfnt Mot. MJ), M J^.H, Td«p»iqn«: rtQ« M^ei •« 

OrffM on WcPMn** HMtti. OAPI PAXi 0021 •f»'?172 

200 lndop>nditn AvCm N>W , nooffl 7304 
WMMpgon. OX. 20201 

OEAOUNC FOR SUBMISSION: FRIDAY. JUWS SO, ISSS 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: Women s Health in f-tedicine: Core Lectures, Electives and Seminars" 



Presenter: Leah J. Dickstein. M. P. Title: Sc?lnll^^'AgfgcS-a?e gl^^"^n^;7..^??!]^-: °.-^, 

School of Medicine Student Advocacy 

Affiliation: University Of Louisvilie Telephone: f^n?) nt;p-^|gc FAX: ,502)852 - 8937 

(Medical School/B«sid«ncy Program) 

Address: Abell Administration Center 202 Louisville, KY A0?9? 

City Zip Code 

Completing the Abstract Submission Form 

■ All tBxt should t>« Typed within the penmeters of the box shown. Fonts no smaller than 10 points should be used 

■ Organize the text of the abstract s« follows: (1) objectives of the curriculum; (2) curriculum description: 
-(3) problems encountered: and (4) reaults. 



1. Objectives include 1. raising awareness among students and residents 
about the necessity of their knowing about the unique Issues in 
illness, diagnosis, treatment, including psychopharmacologic 
differences, of women patients. 2. Presenting this information across 
all four years of medical school, and in psychiatry residency training 
as a post graduate example. 

2. The core curriculum will be described as it is presented to first, 
second and third year students and second year psychiatry residents. 
Elective curricular for students in group and individual electives will 
be discussed. Human development across the life cycle related to gender 
will De explained as background for successful integration of women's 
heaUh. 

3. Problems - few problems have oeen encountered since tne Inception of 
these offerings in the late 1970s because they are labeled and offered 
as relating to gender, i.e. to women and njen, although specifics are 
always emphasized in ey/ery area. 

4. Results - the lectures, electives and seminars are well attended. Group 
interaction Is strongly encouraged, whether with 3 or 135 in attendance. 



Adc'r»'s<; submissions to: Elena Rios. M.O., M.S.P.H. Telephone; (202) 690-5884 

Office on Women's Hetlth, OASH FAX; 1202) 890-7) 72 

200 Independence Ave., N.W., Room 730-B 
Washinqton, DC 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30, 1995 



i 
i 



CULTURAL C0MPST£NC5 AHO WOM£NT HEALTH CUSAlCULAlN MEDICAL twuw-.,,wr, 



ABSTRACT SUBMISSION fORM 

JCtnrJs. J^!t^'Mrr?"-''n''r J^^^y^^^^^ Components Of Tne Fina^ Grade 

•ranter: ^^^;f^f,^n pimitrievlch, M.p. THfe: Assistant Prnf...n. 
umvcrsTty or So urn uakcta — 



.„; |o„, _Sc-hool Of Medicln. TaLphene: »5|35 7-.T532 f^X: (60j 357^1528 

Idria; ^^QQ l^^- ^^nj Street, Sioux Falls, SD 57105 



City Zip CMt 

VV^tfhg th« AbsTTsr^t SubmUsion Form 

1 1 jit t^mutd hm wp«d wvtNn <n« B«rHn«T«r9 of tn« bos showa FflAQ r^ VDtSv ihsA 10 »alnt9 f Hi ^d be mtd 
[v Im t^• t«xt Af »o •tatr^ex M ioiowa; {U ooi»ctir« o< ch« egrricuwn: {2J eurrteu^M Ascription; 



The Corrcladun Between Indi vidual Ct'^mp onents Of Tlie FinaJ Grade Tn T\te Tl\\,d Veai Clerkshin IrLQbatcLnca And 

Gynecology 

E. Dimiirievich MP Umvcr^tv Q f South. Dakot a School Of Medicine 

SioaxFalla.SD 5710 3 



i 
i 

Beginning m 1993, the traditionoJ cleiksliip ui Obsuiiiiini uiid Gvni;culoH> ai Ihe University oi South Dakota 
■J School of Medicine underwent signilicant change in the process by which the thud yeai medical aludcnls were 
■ evaluated. The purpose of tlus change was to unprove Uic overall assessment of the students wiili the innoducuon of tlie 

* Objecuve Structured Cniucal Examination (OSCE). and evaluate whether the methods used correlated well. 

The number ot components used to determine the final grade was increased from four l(.i eight, and the 

i contribution of each component to the final grade was changed from that in previous years 
The compcae.its oi the hnal grade and their contribution as a percentage of the final grade arc ax follows: 
Faculty Evahiarians - 40%, NHMH Shell' Hxam - 5%, Departmental Multiple Choice Test (MCQ) - 10%, Oral 
Fxaminannns - 10%, OSCH - 1 5%. Wntten Case Histories - 10%, Long Essay rcqtiiring literature search - 5%, Oral 

• Presentfltinn - 5%. The lasi four listed arc the new components. 

I A total of .seventy-eight students were evaluated in this way for the academic years 1 903/1 D94 and 1 994/1 995. 

The student*; receivers a percentage grade for each of the components listed above. The grades were then subjected to an 
J analysis to dttlcnmine the correlation between the components listed above. 
I The correlation coefficients, R- . expressed as a mimher from to 1 , between the components of the final grade 

IS shown m Uie folbv in(( table. 

- - - - - - R» 



i 



X Coefficient 


Standard trror ot X 




Coefficient 


0.17 


0.20 


046 


020 


62 


0.16 


O.Of. 


0,13 


0.13 


0.13 


0.25 


0.10 



OSCEADcpartmentai MCQ 01 

OSCE/ Old Exaimnalions 0. 0#i 

.OSCE/Faculty Evaluations n 1 6 

j|Faculty Evaluations/Depaituieuial MCQ 0.00 

■Faculty Evaluations/Oral F.xaminations 0. 17 

Oral Examinations/Dcparnnental MCQ . 07 

1 The lack of COiTelatioQ between tlie cou^>oiiailM ua«:d in the final evaluation pmce<;s indicates that they may be 

roeastmng different skills and knowledge in our sludcnls. It is known thai evaluation tools are limued in rheu* ahihty to 
measure content versus process, and that they also differ in their rcUabihly and validity . The fea.sihility of using multiple 

1 evaluation tools will ditfcr among clerkships and medical schools. The development of innovative evaluaUon techniques 
will perhaps enable us to limit the niimber of evaluation components required m tlie future 




I 0(1(01 «R ^MbnMn'« M««»«. CASH PAX: <202) 890i7t72 

200 TWfUniirtliri Av«^ N.W . fto»n 7304 
WmMf««Tert. o.c 3C201 



OtADLiNC FOR SUBMISSION; FRIDAY. ' JUHL 30. IJIS 



J 



CULTURAL COMPETHNCc AND WOMEN'S HEALTH CURRICULA IN MEDJCAL EDUCATJON 

ABSTRACT SUBMISSION FORM 

Abstrjci Title- A Curriculum on Cc :mfT.uni c ation S<ills ir. Breasz S Cervical 

'Cancsr"'S^reer i"ng"'" ~ "~ "' ~ 



Proseruer: Cathe rine D ube '_. E d .0 . riile: '^.ssistant Professor (Research) 



Broi 



n Oni versity Felephone: 1° ^j 863-2951 FAXi j^h Q^^.-^^li 



Affdisiion 

(Medical Scnool/R€5ii3ency Prngiaml 
Cc-Authors: R.Rosen, R'. Goldman, 6. Eh rich, W.RakowsKi, M. Goldstein 
AddrossPrown tjniv BoxG-BH Ale Ctr , Providence, RI 02912 



Ciry Zip Code 

Completing the Ab:.tract Submission Form 

» All text shoiitrt u« Typed withm the DOfmrtc.fs of tho box shown. Fonts '^o tmaUer thnn \0 Doln^s should bo used, 
« Orynnize lh« text o' tne dbsi'act as followy; (1) objectives o' tne curriculum; (2) curficulum doscnption; 
(31 Drobloms encountered: and f^l results. 



L-_. 



A Curriculum for Medical Students on Communications Skills in Breast and Cervical Cancer 
Screening In collaboration with the CDC and the Association for Teachers of Family Medicine, 
investigators at Brown University's Department of Community Health are in the process of 
developing and pilot testing a communications model and a eight-module curriculum in 
communications and counseling skills to enhance breast and cervical cancer screening. A multi- 
faceted communications model for doctors' interactions with women about these topics has been 
developed. Pilot testing of this model will occur in September, 1995. 

1) Objectives: A.fter receiving a series of coordinated, reinforcing and reiterative reaching exercises 
embedded in related clinical teaching throughout four years of medical school, students will be able 
to; a) discuss breast and cervical screening guidelines and recommendations with women patients; 
b) appropriately communicate risks and benefits of breast and cervical screening procedures and 
early detection; c) effectively communicate with, educate and reassure the patient during clinical 
breast exam, pelvic exam and Pap specimen collection procedures; d) effectively and sensitively 
refer patients to mammography, colposcopy, and other related screening, diagnostic procedures 
and/or repeat resting; e) effectively, appropriately and sensitively communicate, educate and 
reassure patients about positive, negative and suspicious test results. 
2} .Curriculum description : We are in the process of developing an integrated modular 
curriculum including a series of coordinated teaching exercises that will allow complimentary, 
additive and comprehensive teaching to take place. Instructor's guide with supporting instructional 
materials (written materials, teaching slides, and a video component) is being developed. Modules 
in development include: a) Introduction to Breast and Cervical Cancer Screenmg; b) Gender Issues 
in the Doctcr,Tatient Relationship; c) Introduction to Culture in the Docior/Paticnt Relationship; d) 
Communication for Breast Exam, Pelvic, and Pap Test Procedures; e) Cancer Prevention 
Counseling Skills for Breast and Cervical Cancer Screening; f) Cultural Issues m Breast and 
Cervical Cancer Screening; g) Disclosing Suspicious/ Abnormal Findings; h) Comprehensive 
Communication for Breast and Cervical Cancer Screening. 

3) Problems Ekicountered: There is significant interest in including this teaching in the medical 
curriculum. However, since the area of Breast and Cervical Cancer screening overlaps Primary Care 
issues and Ob/Gyn concerns, there has been some polidcal posturing between medical school 
departments that may influence the effectiveness of teaching upon implementation. 

4) Results: Results of the Communications Model pilot test and drafts of all modules in 
development will be available by mid-October. 



<Kj:i''^r- RobmibSions to: Elerio Riot. M.D.. M.S.f».H. Telephone: (2021 690-588<» 

Cffico on Women's HedMh, CASH FAX: (202) 690-7172 

200 indeoeridence Ave., N.W., Room 7 30'B 
Washirigton. D C. ?Q20T 



DEADLINE FOR SUBMISSION; FRIDAY, ^twf^er" 199 5 g 



1 
1 

i 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 



bstract Title: 



Teachine Towards Informed Care of Lesbian P^r-jpnrs 



Presenteri Pam Reid Duffy, PhD. RN 



College of Medicine 
iffiliation: University of Arizona 



Title: A'^g-igr^im'" Pr-nf occn-r n -.-^-i ..--^i ■ Family f. 
Community Medicine 

FAX: (s-^i)! 12^-2^37 



Telephone: (s-^i)) f,^fr-^LM 



' (Medical School/Residency Program) 

lAddress: _jf^ni \\ T,,rQnn rivH iLLL^ 



Tucson, AZ 



85716 



City Zip Code 

Completing the Abstract Submission Form . ,. ^ 

U All Text should be typed within the perimeters of the box shown. Fonts no smaller than 10 pomts should be used. 
U Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) cumcuJum descnpt.on; 

(3) problems encountered: and (4-) results. ^^^^^^^;^;^;^^___^_-__==:=ss====r=^===^=======^=== 



The goals of this presentation are to review a practiced 
curriculum, utilized for over 8 years with medical students, 
primary care residents, and the Western AIDS ETC faculty, to arm 
trainees with the knowledge, skills, and to some extent, attitudes 
necessary to informed care of lesbian patients in clinical practice 
settings. The objectives are: 1) to discuss the rationale for the 
paucity of the scientific knowledge base on lesbian behavior and 
health; 2) to review the history and findings of scientific inquiry 
into lesbian behavior and health, including the status of current 
knowledge; 3) to compare and contrast this knowledge with common 
myths, misconceptions and attitudes held towards lesbian health; 4) 
to identify the consequences of the above on lesbian health and on 
health care delivery to lesbians; and 5) to examine skills 
necessary to informed, competent care of lesbians in practice. The 
curriculum includes: an overview of the history of scientific 
inquiry into lesbian health; examples of interactive 
teaching/learning techniques allowing learners to examine the 
health implications and consequences of uninformed care; and tools 
'designed "for specific skills practice to enable competence. 
Problems encountered will included content on the implications for 
faculty in teaching this curriculum, including suggestions for 
problem resolution. A discussion of results will examine the 
effects of curricular implementation on faculty development as well 
as critical incidents in medical student behavior change following 
training. 



Addfttss submifisioris to: 



Elena Rios, M.D., M.S.P.H. 

Office on Women's Health, GASH 

200 Independence Ave., N.W., Room 730-B 

Washington, D.C. Z0201 



Telephone: 
FAX: 



(202J 690-5884 
(2021 690-7172 



DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. 1995 



CULTURAL COMPETENCE AND WOMH^'S" HEALTH CURRICULA W MEDICAL tUUUM i t^v, 

ABSTRACT SUBMISSION FORM 
Abstr;,ct TitJe: Teaching Ethics in OB/GYN Residency Education; a Modf=>l 



Presenter: Thomas E. Elkins , MB Trile: Deoartn^n^ rh^^r^.. ^--^7--n PI— nj 

AffiUaiion: LSU Medical School Telephone: ^0^ 565 - 4852 faX; g04 568-5149 



7011 



(Medical 5ch«ol/R«j(4efWT Program) 

Address: _1542 Tulane Ave. New Orleans 

City Zip C©da 

Comp/edng thfi Absrrsci •SuDmissron Ferm 

■ AS i£xt s^tDuid b« tvpad witfrtn tn« pcAmeTcts ef tha box sho«vn. Ponti no urntiiv ihan 1C points thr ni j be uud. 

■ OfS«ni2« tfte \9jx of :he itevact m fdlowa; {IJ oBjeciiv«5 0/ tha curncuurn; (2; cufrtwk^n 4«*crijrtion; 
rSl problams eneeuntsred: and <&) m^Cs. 

Cuniculum obiectivx^s : A 1992 national survey conducted by CREOG demonstrated that implementing ethics 
education within an cbstetncs and gynecology residency program contmues to prove difficult The respondents 
tD this survey appeared to have a great deal of interest, but limited guidance. Two questions posed particuJariy 
challenging problems Fust, can ethics education be evaluated so as to determine whether the effort to construct 
such a program for r>5sidents makes a difference? Second, can ethics education be substantial and yet not be one 
more burden in an already stressfiil residency? 

Curriculum descapiion : This currioilum is built around four propositions: (1) Ethics has to do with the 

i determination of what ought to be done, all things considered; (2) The central ethical issue of medical ethics is 

how a padent and a physician form a relationship and how they actually relate to/with each other in the delivery 
r. of care; (3) An eth'cs curriculum in a residency program should relate immediately and specifically to the 

t; residents' clinical experience; (4) If patients are more than (potennal) illnesses/diseases and professionals are 

more than highly skilled technicians, then a discourse other than a stricUy scientific and medical discourse is 
necessary. 



" The oeadon of this^uniculum has required four steps. First, an evaluation and feedback instrument has been 

I designed and field-tested. This instrument— which is administered armually— gathers feedback about ethical 

priorities for residents, monitors resident development of thought about ethical issues in obstetrics and 
gynecology, and assesses resident familiarity with ethics resources. Second, a two-year series often conferences 
has been integrated into the residency program's didactic schedule. These conferences work with subjects 
addressed in APGO's Ethical Issues and Legal Issues monographs and with the ACOG Ethics Committee's 
position papers. Third, an Ethics Education Comimttee has been formed. This committee reviews all facets of 
the curriculum, fourth, the fadiitator cfthe cumciilum has recently begun to rotate with the high-risk obstetric 
service and with the gynecologic cancer service. 



grofalems encountered : Time. 

Results : AH parts cfthe curriculum have been implemented, efiective July 1995. Baseline information has been 
tabulated and ar Tlyzed (summarized in this presentation). 



iddresa submissions to: Qcr* Riot. M.O^ M.S-P.H. T«Jeprion«3 (202J 690-S86A 

On*e« on Viommn's. Hoahh. ©ASH FAX; <202) 69>7l72 

W«9ft»ne«0f). O.C- 202O1 

OEAOUNE FOR SUBMISSION: FRIDAY. ;jyNE-30rT996 




10 



1 

I CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 



ABSTRACT SUBMISSION FORM 



1 

abstract Title: Woren's Health Clerkship; Stanford University School of Medicine 

I , , Marita Grxidzen, MHS 

^f» |2nTer:Ele^ior^_Segar^J;© Tale: Co-Directors 



,f*;^.ation: Stanford University Telephone: f 413 725-^4480 ' FAX: mS) 723^9692 

(Medtca. School-'ReSidsncy Program) 



I 



Vd-iress: n-iv-ic^snn o^ T=^iW and ConiTTunirv ?-fedicine. 703 Welch Rd, G!, PaJJJ Alto CA 94304 
I Ciiy Zip Code 

^ompleilng the Absuact Submission Form 
Aii \ixz sr.oulO &• lypeo wi:r,in ir.e pcrjm*'.efs ai me cox shown, fonts no smalier tnan 10 po»nrs sftouJa be u5ed. 
Jgaatze the text or tne AOstracr as Joiio*v5. {7^ oc;ewUv«s vjf u.» cur«'wk<2u«<'i; !*) cu»vicul»rf.Ti Cdscr;pt:cr.; 
i prooiems encounterea; and (4.i resuJts. 



I 



C 



A cora curriculum in women's health for medical students has 
been established at Stanford University School of Medicine 
through a two-week clinical cler]cship. The primary goals of this 
clerkship are: 1) to educate students about the major health 
concerns of vomen including issue of age, class, ethnicity and 
sexual orientation, 2) to provide the skills to thoroughly and 
sensitively treat women patients, and 3) to encourage the process 
of critical thinking about gender issues in clinical research and 
treatment. The clerkship begins with an introduction to the 
doctor-patient relationship, and to the healthcare seeking 
practices of women. Then, through a life cycle approach, women's 
health issues from adolescence to geriatrics are reviewed. 
Special topics include sexuality, mental health, breast health, 
skeletal health, cardiovascular health, and violence against 
women. There are sessions on biological, psychological and 
sociological transitions, such as menarche. The course wraps up 
with a focus on prevention and health maintenance to emphasize a 
model of women's health. Each subject was designed by a "content 
expert" faculty member and contains well-defined goals in 
knowledge, skills and attitudes. The clerkship includes didactic 
and clinical experiences. The clinical sites emphasize 
eunbulatori care but include specialty services such as breast 
clinic. Planned Parenthood, and sessions with practitioners who 
examine and treat victims of sexual assault. Also students can 
assist with several ongoing clinical research studies such as the 
Women's Health Initiative. Initial challenges have involved 
identifying faculty who would commit to the design and teaching 
of the curriculum, funding sources and an administrative home, as 
well as securing the approval of the Committee on Courses and 
Curriculum. The Division of Family and Community Medicine has 
sponsored the course and asked Marita Grud2en,MHS and Eleanor 
Segal, MD to serve as Co-Directors. Approval has been granted to 
offer the clerkship beginning in the 1995-96 clinical year. 



fedf.-J^'i submissions :o =!«^3 p.-cs. V.D., M.S.P.H T«ieoKone: (202) 690-5884 

J O'vre r.n Woren c Heaur GASH FAX: (202) 690-7172 

200 ir.jjecer.de-^ce Ave.. N "tV.. Room 730-8 
. Wa.s.-Mngjon. O.C. 20201 

'' DEADLINS FOR SUBMISSION: FRIDAY, JUNE 30. 1995 



1 



11 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: '^ask Force on Reproductive Science Expands Horizons 



Presenter: Nancy S. Hardt, MP Title: Associate Professor 



Affiliation: University of Florida Telephone: POA) 395 - 0238 FAX: (904-395-0437 

(Medical School/Residency Program) 

Address: Dept. of Pathology and Laboratory Med. Gainesville, FL 32610 



P.O. Box 100275 City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

■ Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(31 problems encountered; and (4) results. 



TASK FORCE ON REPRODUCTIVE SCIENCE EXPANDS HORIZONS 
N. S. Hardt MD, L. Doty PhD, A Pawlina MD PhD, S. Nermann M.D. 

Introduction: In September 1994 a task force was convened to develop comprehensive basic science objectives for the 
curriculum on reproductive science in the College of Medicine. The group represented Psychiatry, Anatomy, 
Pharmacology, Ob-Gyn, Surgery/Urology, Biochemistry and Pathology. Teaching objectives and course content were 
reviewed. 

Success: The reproductive sciences were taught well as measured by performance on standardized examinations. 
Students receive repeated exposures (at least 3) to topics such as breast cancer, prostate cancer, cervical cancer, 
venereal disease, HIV, contraception, pregnancy. 

Need Improvement: Psychosocial aspects of reproduction were covered one or less times in the curriculum, including: 
sexual history taking, warning signs of domestic violence, physician and patient sexuality, assault, substance abuse. 
Physical examination of genitalia had not been integrated into physical diagnosis. 

Recommendations: 1) Gear curriculum in reproductive science to the list of 29 common clinical problems. 2) Teach 
examination of genitalia during the student's first exposure to physical examination to remove the student's impression 
that this is only done"by specialists. 3) Cover each common problem three limes in the four year curriculum. Exposure 
to clinical problems during the basic science years helps students to focus. 4) Minimize departmental boundaries to 
have a student based curriculum rather than a faculty based curriculum. 5) Interdisciplinary oversight can best steer 
teaching of human reproduction and related topics. 

Early Result: The concept that interdisciplinary task forces can recommend content in specific subject areas was 
accepted by the full curriculum committee. This interdisciplinary group was also accepted as a component of periodic 
peer evaluation of teaching. 

Problems Encountered: Departmental turf wars have not gone the way of the dinosaur. 

Bonus Result: A commitment to improve teaching of psychosocial aspects of reproduction continues. This was an 
unanticipated bonus. Members of the task force now work together in interdisciplinary approaches to improve basic 
science teaching. The vision was shared, and the grassroots effort continues. 



\(MrR5s submissions to: Elena Rios, M.D., M.S.P.H. Telephone: (202) 690-5884. 

Office on Womens Health, OASH FAX: (202)690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAJ, JULY 21, 1995 



12 



I 

CULTURAL COMFfT0JC5 AND WOMCN? HEALTH CURWCULA iN MKHCAL tuuw^nv.* 
I ABSTRACT SU3M1SSJ0N FORM 



^J,xt>r. Wiiniam H. Hindle, M.D. Tttte: ,. , 

f fi ttjon: use School of Medicine Tdephorie: fPU ?Pfi-4018 ^A^- (Pll P?':-?^? ^ 

i. !r55n^^^ U^'^'"^ D^"?^^ ^P^^^ni? Hospital Los Angeles, CA 90033 



CrtY 



Zip Cod« 



ometettna th« Abstract Sufemiwon ^'omi 

A icxT ahe^M b« tvptd within c*» otfinmun of tJv box shown. Ports no *miU«f tJan 10 p6Ja» should bfl us«d. 
C C^ tM tB« 6t the «b»t»»ct as Wtows: £11 oojeccwes Of Che curtcalum: UJ CurrtcwJum dwcrwoon; 



i 



ijective of Curriculum: The Breast Diagnostic Center was established within the Department of 
Obstetrics and Gynecology of the University of Southern California School of Medicine at Women's 
i Ik Children's Hospital, LAC + USC Medical Center, Los Angeles, California. Subsequently an 
educational curriculum was developed for the Ob-Gyn resident physicians, the second and third year 
j^edical students, and the patients. The patients in this county hospital are all classified as medically 
i |derserved and mort than 80% are Hispanic. 

Curriculum Description: A core breast curriculum was developed covering anatomy, physiology, 
Jthology, and treatment. Techniques of fme-needle aspiration, mammography, and surgical biopsy 
|e explained to students and taught to the resident physicians. Texts, conferences, lectures, and 
videos (and ''hands-on" experience for the resident physicians) are utilized. 
Problems Encountered: Agreement in principle and the cooperation of the Departments of Pathology 
Jxrgery, and Radiology were negotiated over lime and clinical protocols agreed upon. 
Results: Approximately 9000 patients, 859 medical smdents and 105 resident physicians have been 
irved and educated in ojeast care and evaluation. 



J 



i 
r 



*ubmis»»90» tr. S9n« ftioB, MX^ A*.Si^.M. 

Otf(e« on WomMfs H««tm. OaSH 

WvNnQtan. O.C. 2C201 



r«Uphenft: 
FAX: 



(202} 690-5MA 



OCAOUNE FOR SUBMISSION: FWDAV, 3«NE-3err«96 



13 



f 



f 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: Assessing Training Effectiveness for Health Care Providers f 

Presenter: Carol S. Hodgson, Ph.D. jj^lg. Assistant Professor 

UCLA School of Medicine 

Affiliation: Educational Development & relephone: (319 794-7530 p^X; (3ip 794-7465 

(Medical School/Residency Prograrn) 

Address: 10833 LeConte Avenue, Room 60-048 CHS, Los Angeles. CA 90095-177? 



r 



City Zip Code 

Completing the Abstract Submission Form 

■ All rexr should be typed withm the perimeters of the box shown. Fonts no smaller than 10 points should be used 

■ Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. 

-= : ^ ■■ = =^jf 

Background and Need . Family and intimate violence is an urgent public health problem that has devastating physical and emotional 1 
consequences for women, children, and families. Women are more frequent targets of both physical and sexual assault by partners and 
acquaintances than by strangers. Studies suggest that as many as 30 percent of women treated in emergency departments (ED) have 
injuries or symptoms related to physical abuse. A great need and interest exists in improving the response of primary health care 
providers to abused women. 



Purpose. The CDC Division of Violence Prevention has been charged with working towards the primary policy goal of increasing 
physicians' ability to identify and attend to the needs of female victims of family and intimate partner violence. To accomplish this goal, 
effective programs must be identified which can be disseminated through regional or other broad-based training centers, or recommended 
to constituents seeking model programs in this field. In 1994, the CDC selected the Doctoring curriculum at UCLA as one of two 
programs to evaluate for this purpose. Here we describe a pilot evaluation of the UCLA program. 



F 
F 

F 



Description of the Curriculum . One of the components of the UCLA Doctoring curriculum is the small group problem-based-leaming 
(PBL) approach. The PBL modules center around important clinical concepts such as teenage pregnancy, homelessness, and domestic J^ 
violence. In the Domestic Violence Module, students interview a standardized patient who is in a continuing relationship with an abusive 
partner. Students learn proper interviewing techniques to develop rapport and counsel the patient. 

Method . A pilot study of the Doctoring Domestic Violence Module was performed with ULCA affiliated medical students. A sample p 
of convenience composed of 14 second-year medical students was used for the pilot. A pre-test of existing knowledge, attitudes, beliefs, 
and behavior (KABB) was given to the sample just prior to the students' participation in the Domestic Violence Module. Students were 
given a number of statements and were asked to indicate if they strongly disagreed (1) to strongly agreed (7) with the statements. Post- P 
test measures included a survey to assess group process and the student's attitudes about the utility of the various components of the t 
module. Students also assessed their attainment of knowledge from participation in the module. 

Results. Results from the pre-test indicate that before participation in the Domestic Violence Module, many of the students surveyed didP- 
not see an important role for physicians in the prevention of or intervention with domestic violence. When students were given the 
statement "given the many threats to health that exist, it is unrealistic to devote much time to domestic violence." The vast majority of 
students (86%) either agreed to strongly agreed with the statement. Students' response to "It is inappropriate for physicians to intervene j^ 
in situations of domestic violence unless specifically requested by the patient" 21% (n=3) disagreed or strongly disagreed while 64% 
(n=9) agreed to strongly agreed. When asked if they could gather information from a patient to diagnose domestic violence 23% felt 
they could while 46% felt they could not. After completion of the module, students were asked to indicate what they had learned from «■ 
the experience. Nearly all the students (93%) indicated that they had learned about the predisposing and predictive characteristics of I- 
abusers and victims from some to a great extent. All the students indicated that they had learned about the incidence and prevalence of j 
domestic violence from some to a great extent. All but one of the students felt that they had learned interview techniques to detect the \ 
presence of domestic violence to at least some extent. Even though prehminary, these results indicate the need for educational f" 

interventions for medical students. _-— — — 



-I 



\(i.1re?--. submissions to: Elena Rics, M.D., M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health, GASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington, D.C 20201 



F 

14 r- 

DEADLINE FOR SUBMISSION: FRIDAI. JULY 21, 1995 f 



I 

I 



A c s : ' 3 c : 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA iN MEDICAL EDUCATIC, 

ABSTRACT SUBMISSION FOR^I 
'Xo-er.' s Healtr. Track in an Internal Medicine Residency Prrzrir. in a Co:?" 



I 
I 



co-author Janice Werbinski, MD 
Sandra J. Hoffmann, MD ^it:r Assistant Prof essor of Medicine 



Set t mz 



c 5s r : or ; 

Michigan State '^-^ _ ,-,-., 

t:,KK;on: University . Telepnone: i6I6 337 -6357 FAX: ; ' 33.--^^3h 

iMeaicai Scnool. Residency Program; 

1000 Oakland Drive Kalamazoo Michigan ^9008-129-^ 



(ccress: 



l| City Zip Code 

Completing the Abstract Submission Form 

A" 'ex: should be typec wtr'- t-"? ::e'rpete's of the box shown. Fonts no srriafi-- -ran 10 pcirrs srculd be use 

Organize the text of "the abstract as follows: ID objectives of the curriculum; (2) curriculum description; 

(3) problems encountered: and '■^'t results. 



I 
I 



i 

I 



Objectives of the Med-Women's Track Curriculum of MSU/KCMS College of Human Medicine: 

1. Management of conditions unique to, or more common in, women or for which there are differences i 
in diagnosis and treatment. ; 

2. Ability to take an appropriate history and perform a complete, sensitive, and comfortable physical \ 
examination. i 

3. Knowledge of factors determining "women's wellness", disease prevention, and the recognition of .j 
psychosocial, economic, and external violence factors influencing women's health. \ 

4. Knowledge of reproductive choices to facilitate maximum personal choice of the woman patient. 

5. Promotion of the patient-practitioner partnership in clinical decision making and education. 

6. Critical evaluation of new research data and its impact on women's healthcare. 

The curriculum consists of six one-month electives designed to accomplish the above objectives. 
The resident will be assigned to electives in Women's Cardiology, Women's Psychiatry, The Adolescent 
Female, Geriatrics for Women, Advanced Gynecology, and Advanced Office Procedures for Women. An 
extensive reading list and bibliography has been designed to promote self-study, and the resident is 
encouraged to expand his/her knowledge base beyond the basics to include study of gender differences in 
assessment, procedure performance, procedure interpretation, pharmacologic response, and therapies. 
Women's Track residents will be encouraged to highlight these differences during rounds, case 
presentations, and other group educational pursuits. 

In addition, a monthly evening "Feminar" didactic lecture series will be part of the program. Local 
clinical faculty will be invited to present or participate. The resident will be responsible for designing and 
implementing at least two of these sessions per year. Topics will be rotated in an 18-month cycle, so 
various topics can be revisited as the resident becomes more advanced in his/her training. Topics to be 
rotated include: Gastroenterology, Infectious Disease, Rheumatology, Breast Health, Dysfunctional Uterine 
Bleeding, Menopause, Teen Sexuality, Depression, Endocrinology, Autoimmune Disease, Osteoporosis, 
Thyroid Disease, Diabetes Mellitus, Eating Disorders, Incontinence, Endometriosis, Infertility, and Medical 
Disease in Pregnancy. 

Results and problems encountered are not yet able to be delineated, as the program is slated to begin 
July 1, 1996. 



VMrP<-. subm.ss.ons to: Elena R.os. M.O.. M.S.PH. Telephone: (202) 690-5884 

IOff.ce on Women's Health. OASH FAX: (202) 630 71 71 

200 Indepenaence Ave.. N.W , Room 730-B 
Washington, D.C 20201 

I DEADLINE FOR SUBMISSION: FRIDAT, JULY 21. 1995 



15 



Jl 



w;j 



CULTURAt COMPSTcK'CS AND WOMSN'? HEALTH CyRRICULA IN MEOICAU fcyww*».wni ' 

A85TRACT SUBMISSION FORM 
sifuc' Titia- A Maternal r.h ild ^e^lt^. Clerkship: Developinc an Understanding of t^.e Pati ent/Physi' 
Thomas A. JcMnspn. v.O. Titia: Director of Medical Education 



3«mtr: 
'iUatien: 



UMass Medical Center Telephor^e: ^OS, 85^-3649 p^;^. W ^^.^'^^^^ 



(M«dieal ^hoeL/t<-si^ney ^aram) 



dr»M: OB/GYN. UMasj Medical Cqnte^. 55 Lake Avenue N. Worceste r, MA 0165:) 

City Zip C9^ 

mpietin^ th9 Abftrset Submitsion Fcrm 

J text ihouid be typed witttin vn ocnmcttrs of ih« box ihewn. tans m •m«({«r than 10 points sHomM te yud. 
HQMO* tM tBt of 9« aMin^t M 4«0ow«: U) Oi^aCfVf* Of ch» cuffteUum: (2) Currfeuium ditcipKon: 
3> pfoMawB 9neountawii ind (*> fenm. 



^a^mm 



A MATERNAUCHILD HEALTH CLERKSHIP: DEVELOPING AN 
UNDERSTANDING OF THE PATIENT/PHYSICIAN RELATIONSHIP T. A. 
Johnwn. The University of Massachusetts Medical School (UMMS), Worcester, MA, 
01655. 

This new 12-week joint obstetrical and pediatric third-year clerkship has the following 
educational goals: 

1 . to provide a substantive longitudinal patient experience associated with childbirth, 

2. to improve student understanding of the biopsychosocial components of maternal 
and infant health and, 

3. to facilitate student awareness/understanding of the patient/physician relationship. 

Two pitients who will deliver during the 12-week period are assigned to each student. 
Students attend all prenatal visits, the delivery, neonatal and health supervision visits, as 
well as home visits. Students are available to the patients 24 hours a day through an 
assigned pager. A weekly two-hour seminar addresses a number of nugor public health 
issues, while offering students the opportunity to discuss the relevancy of these and other 
issues iJTthe lives of their patients. 

The first 18 months of the program, involving 56 students and 1 12 patients, has been 
evaluated using, in part, a student self-ef5cacy scale, &culty review of each student's 
log/escay, and struaured patient interviews. Evaluation has revealed enthusiastic student 
and patient acceptance of a program which demonstrates improved student 
understanding of both maternal/child health biopsychosocial issues and the patient 
encounter. The UMMS is adapting this educational model for use in other third-year 
clerkships. , 




Idracs submission* ;o: 8en« Mot. M.Oi, M.S^.H. 

Offteo on WeoMn'o Htohh. OASH 

W»sMr«wi. O.C. 20301 



fAX: 



1202) 6ft>$MA 
(202) 6*^7 172 



OCAOUNE FOR SUBMISSION: PfUOAY, JOWC.00. iflSfi 



16 



CULTURAL COMPETENCE AWO WOMEN'S HEALTH CURRICULA IN MEDJCAL EDUCATION 

ABSTRACT SUBMISSION FORM 

A Program to Promoce Medical Students Appreciation of the Nurse's 
Abstract Title: Rnlo in Lahnr and Dp 1 t vp ry . ( L&D 't 



Presenter; Kp.nnprh R. Ke liner. M. D . .Ph . tFltle: Profgs.sor 

University of Florida 
Affiliation; CcW^.rxa of Medicine Telephor^e: /904 392-2894 FAX; '. 90Y^ 39^-2808 

(Medical Srhocsi/Rcstdencv Program) 

Address: P . 0. Box 100294 Gainesville, FL 32610-0294 

City Zip Code 

Completing the Abstract Submission Form 

• All texx should Ofl typM witnin rtte pertmettfrs of th« box shown. Fonts no sma.'ier man ] posnts snoufd be used 
■ Organize xHe X9XJ Of t^e atKcr^ct 8S loiior^s: H) objectives ol vne curr»cu>uoi; (2) curricuJum desc.'ipnon, 

(31 probiems encountered; and 14) results. 
B ~ ■ ■,„■■■ 



A PROGRAM TO PROMOTE MEDICAL STUDENTS APPRECIATION OF THE NURSE'S 
ROLE IN LABOR AND DELIVERY (L&D). K. Kellner, K. Harmon, University of Florida, 
GainesvUle, FL, 32610-0294 

Medical student evaluations of the OBGYN clinical clerkship repetitively scored their 
relationship with L & D nurses as poor and this was echoed by nursing. Inspired by a 
resident-nurse program at the University of Kentucky* a program was initiated for 
medical students to shadow a nurse in labor and delivery. One student is paired each 
day, early in their obstetrics rotation, with a nurse to function as a nurse's aid for the 
eight hour day shift. In the first year 107 students and 27 nurses participated (21 more 
than once). The program was evaluated by questionnaires completed by both student 
and nurse at the end of the day. Student responses were counted once for each student 
while nuije;? responses were counted once for each session. Both students and nurses 
found the program enjoyable (88% and 93% respectively) and worthwhile (98% and 
94% respectively). Both (91% of each) felt the program improved studenf s appreciation 
oFwhat nursl: do and similar percentages felt it increased students' respect for the nurse 
as a member of the team. 93% of nurses' responses indicated increased appreciation for 
the student as a member of the team. No one felt patient care had suffered. Almost all 
nurses indicated a desire to participate again (78% did) and would encourage other 
nurses to participate. 92% of the students would encourage other students to 
participate. Overall, only four negative responses were obtained and were the result of 
inaccurate student expectations early in the program. Particularly significan. ihat 
since the program's inception no negarive comments have been elicited from the 
students about L & D nurses in post rotation debriefings. In conclusion, the program 
has been very successful in improving student-nurse interaction in labor and delivery. 
* Johnson, et al. Acad Med 1992; 67:439 



Address suboi.ssiors to: 6len« Rios, M.O , M.S.P «. Teiephona: (202) 690-5884 

Office on Women 8 MeaJth, OASH FAX: a02\ 690 7172 

200 Independence Avs.. N w.. Roorr) 730B 
Wasnington, Of: 20201 

DEADLINE FOR SUBMISSION; Friday, August 4, 1995 



17 



CULTURAL COMPETENCS AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Ab«r»ct Title: Teaching Women's Health In the Outpatient Setting 

PreMmer: Rebecca A. Knight, M.D. j,„^. Internal Medicine Resident PGY--? 

AHllLtlnn: ^^^^ ' ^^^ ^Hinols at ' f.l'.%::n.: i''^ ^ ''''-'''' PAX: ( 3^9/655-6879 
{Mvdieal Scfteet/ntaldonov Proa/«m) 

Address: St. Francis Med. Center, 530 N.Z. Glen Oak Ave.. Peotfa. TT. fi1fi?7 

City Zip Codt 

Complotina 2h« Abstraet Sufamitslen Form 

■ All t«Rt th9U4 b« typ»4 within ihs peHmttari Df (h« box ahown. Ponti no smttef ffnan tO poinu ihould b» us«d. 

■ OfBaniza th« taxt of tha Abitrcet m teUowv. (1) oNietivai of th« ewrrlcubm; (2t eurrteuMn daawlption; 
0> problem* tneauntartd: and {41 PMulti. 



We designed the women's health cumculum to address the needs of female 
patients that came up in the outpatient setting (e.g. menopause), to explain 
approaches to sensitive topics occurring more often in female patients (e.g. 
domestic violence), and to address common problems that present differently 
in females than males (e.g. alcohol abuse.) The result was a collection of 
journal articles that were obtained by two methods: Articles that had been 
saved over the years by the director of the clinic and new articles found 
through a computer Uterature search. The articles were then compared and 
the best one selected for each topic. Each topic was then introduced with a 
one page summary or tips and then the article. Some of the problems 
encountered, were photographs did not copy well, and some topics were 
underrepresented in literature and articles that fit our curriculum style were 
not available. The final result was a two volume set that took us half a year 
roughly to go through. We spent the first 1 5 • 20 miiuites of our clinic day 
with our supervisor discussing a topic and the associated article. Most of the 
articles resulted in good discussion and practical knowledge. We will repeat 
the series every three years approximately and update it as we go. 



AddfMs tutiniiisient to: Cl«na R,og, M.O., M.8.P.K. Talvphon*' 1202) atO>ll6« 

Of«ie» en WwTt«n'« Haarih, 0A8H PAX: (202) eaO-7172 

200 ind*p*nd«rte« Av«., N.W.. Room 730-0 
WMhrngton. O.C 20201 

DEADLINE FOR SUBMISSION; H^IDAY. JUNE 30. 1S95 



18 



' 



i 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION f^ORM 



lAbstracx Title: Women's Health Currioiluro Il^jpf? A MnUirfisciptinar-y Appmarh 

■ Mitri Krockovcr, M.D.; Janet Pregler, M.D.; 
Presenter: and Jodi Friedman. M.D^ Title: 



■Affiliation- UCLA School of Mcdicioc Telephone:! ^ ,nfl-70a-QS,in PAX: ( j jo 70r . tiX3J 



i 



'Affiliation: 

(MedicBl SchooiyRa«idency Proflraml 

Department of Iniernal Medicine. Division of General Internal Med 
Address: f ^n lUcdufli P I 117.1 Sniff 7^0 Tn %4n fT Ple« CA S ) ()Oftg 



City Zip Code 



J Completing the Abstract 5ubmi«»'af» Form . „ ^ <-. u. j 

I . All Text .nou.d bo ryp«d w.tN« the p^rimetprs of the box aho^n. Fon.» no «meMar Than 10 po.nts should b« used. 
■ ■ Oro.nize the tmt o/ the abstract aa follows. lU objectives of tha curricu/um; <2) curriculum dc=cnpt.en: 



li 
i 
i 
i 
i 

i 

^ L 



Organize 

(31 probiama •ncountered; •nd {*) results 



The ohjectivcs of the UCLA Dcpurtmcnt of Medicine Women's Health ProKram are to train 
physicians and physicians-in-training ahout the primary' care of women using a comprehensive and 
multidisciplioary approach; to increase the: awareness of these professionals about the limitations 
and opportuiiities in women's health research as it impacts on the care of women: and to increase 
the awareness and knowledge that women's health is impacted by multiple factors including gender, 
race, culture^ and socioeconomic status. 

These objectives arc accomplished in a vanety of modalities and sites emphasizing a 
muliidisciplinary approach. At the uodergraidiiate le\'el. female facult}' pliysicians direct a coui-sc on 
women's health issues. The medical school curriculum integrates women's hcaltli issues tlirough 
problem-based learning, ;i domestic vioieace module, and rotation of medical students through the 
primaiy care-based Iris Cantor-UCLA Women's Bealth Center, which integrates health care delivery 
to womcr. vnih on-gomg research and education. Internal medicine residents Icam about women's 
health issues through didactics, clinical rotation* including tlie Iris Cantor-L'CLA Women's ifculth 
Center, an internal medicine consultation clinic at the Westside Women's Health Center, a non- 
profit cli.iic that serves medically indigent women. Other educational activities provided for residents and 
facult>' include a weekly case conference oo primar> care women's health issues, the Women's Health 
Grand Rounds, a montliiy muitidisciplinarv-lconference on women's health issues, and an annual CME 
conference on women's health issues for practicing piiysicians. 

There have been relatively few probiems encountered using this approach, which has been 
accomplished through llie use of faculty phj-sicians, and integration of curriailum into standing programs. 
The emphasis on primary care has been increasingly supported over the past few years. Opportunities to 
enhanre t*ic program and proA ide more care to medically indigent populations requires additional funding 
to support facult>' time for development and implementation of continuity care and for expanded patient 
services at outside sites such as the Westside Women's Health Center. 

This mtegraicd and multi-faceted program has resulted in the accomplisluneni of our objectives 
in a relatively sliort penod of time. The program lias also led to increased collaboration between 
multidiscipliuary specialists which has expanded u-aining opportunities, educational programs, and an 
integrated approach to women's health care. Additionally, exposure to clinical trials in women's health 
research has provided an opportunity to relate thnt research to daily clinical caie and to provide 
opportunities for interested individuals to pursue thai avenue ol endeavor. 



Address sobmiasions T«5; Elena R'os. M.D.. M.S. P.M. Telephone: (202) 690-S88A 

Oflica on Women-* Hesllh. OASH FAX. (202» 690-7172 

ZOO IndependBOce Aw«.. N.W . Room 730-8 
Washington. DC, 2020 1 

DEADLINE fOR SUBWISSION: FRIDAY. JUNE 30. 1995 



19 



r 

CULTURAL COr/PETF-.NCE A.ND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM F 

Abstract T.tle. Primary Care Training for Ob-rvn Residents: A Collabora t ive P vQJecl 

r 

PrpcpntPr- Melodee Laskv, MD & Scott Grav , M DTitle: Directors Somer set F.P .Residency & ... 

^ -S Bmerset F .P .Residency RWJ-U>ffiNJ Residency 

;^jl^l^Ql\Q^^: RWJ-UMDNJ Ob-Gyn Residency Telephone: (QOA (^rs-9rqq FAX: bn«) 70^-0083 ■_ 

(Medical School/Residency Program) 

* _,_, Somerset Family Practice, 110 Rehill Ave., Somer ville, NJ 08876 W 

Address: " — — r z: r~~ T 

City Zip Code [ 

Completing the Abstract Submission Form „ . ,n • k ^ k -h 

■ All text should be typed wilhin the perimeters of the bcx shown. Fonts no smaller than 10 points should be used. 
> Organize the taxt of the abstract as foliows: (D objectives of the curriculum; (2) curriculum description; 
(31 problems encountered; and (4) results^ - 



In 1992 the Council on Graduate Medical Education recommended that 50%of all physicians be practicing 
generalists. With the current market trends and managed care emphasizing care provided by primary care 
physicians, it is anticipated that it will take about 40 years to attain this target distribution of physicians. The 
development of opportunities for primary care education is gaining increasing importance for OB-GYN training 
programs across the country. Many women seek regular care from their OB-GYN physician and identify this 
physician as their only continuity provider. Broader training in primary care for women by OB-GYN residents 
will allow improved management of the comprehensive needs of these patients. In this project, collaboration 
between a community hospital family practice residency and a university-based OB-GYN residency provides an 
educational model aimed at providing primary care residency training to OB-GYN residents. 

Overall Goal: To train OB-GYN residents to be able to provide respectful women-centered comprehensive, 
continuous, and longitudinal primary care. They will be able to coordinate medical, social, and mental health 
services including consultations and referrals. Objectives: 1. Utilize collaboration between a university and 
community ha^ residency; 2. Utilize collarboration/sharing of teaching resources bewteen two specialites 
(Family Practice ad OB-GYN); 3. Increase the number of appropriately trained physicians providing primary 
care services to an important segment of the population 

Curriculum description: 30 weeks of primary care training will be incorporated into the 4 year OB-GYN 
curriculum. Each OB-Gyn resident will spend 20 weeks in primary care training in the first year and an 
.additional- 10 weeks in the.PGY-3 and PGY-4 years. Educational experiences will center around ambulatory 
primary care. Rotation blocks will include a combination of in-patient, out-patient and community oriented 
activities. Training in longitudinal care, a cornerstone of primary care, is provided in the family practice office 
and a community based Women's Health and Counseling Center. The primary care focus is being integrated 
into the university based OB-GYN program through Primary Care OB-GYN Grand Rounds. A longitudinal 
care curriculum is plarmed for the gynecological and obstetrical clinics in the OB-GYN residency as well. 

Problems encountered: 1. Negotiation of time allotted for primary care; 2. Agreement on the definition of 
Primary Care OB-GYN; 3. Controversial nature of project due to ownership of the title of primary care by 
both specialties; 4. Collaboration of community and university-based programs, especially with regard to re- 
imbursement and payment of residents; 5. Acceptance of primary care training by OB-GYN residents 

Results: The Priinary Care OB-GYN Project is beginning this July with excited residents and faculty. 
Objective and subjective measurements of the curriculum will be obtained. 



Address subm.ssicns to: Elena Rios. M.D.. M.S.P H. Telephone: (202) 690-5884 

Office on Women's Health. OASH FAX: (202) 690-7172 

200 Independenca Ave , N.W , Room 730-B 
Washington, D C 2020 1 

DEADLINE FOR SUBMISSION; FRIDAY, JUNE 30, 1995 



20 



( 



CULTUAAL COMFETENCS AND WOMCM'J HEALTH CUWUCVLA W MEDICAL tUUWM 



I 
( 

j AeSTftACT SUBMISSION FORM A/^.'^ U^m^r\'b Z^^olI ^ 

' AttSXraet Title: an§^B^gg§^l§^r^^sglegg^^f^^^gagg^ Research Regarding Mwl f in Obstetrics 

I Pftt^anterr '^""^ LaValleur. M.D. Ti^, Assi stant Professor 



Affiliation: university of Minnesota _ Tdltphflne; ^1^ 625r5979 p^^. j612i 62^-0665 

Addrttat ^°^ "^^^ "^'^^ "^^^ Delaware St. SE Minneapolis, MN 55455 



-. . .. City '. ZioCeda 

Comptatft^ thi Aittraet Submfsiion Fdrni 

• Al tMt ^'tmM b* tvp«d within w* ecflmtttn •# th« box «h«jwn. ^onti m tmauv than 10 ocwtts ahaiid Im x»m* 



A National Survey of Education and Research Regarding Mature Women's Health in Obstetrics 
and Gynecology Residency Program, June La Valleur, M.D., Ben Bomsztein, Ph.D. 

PURPOSE To examine the cxuricular content of Obstetrics and Gynecology (Ob/Gyn) accredited residency programs 
throughout the United States. To assess in these programs topics of research and concordance with the Council on 
Resident Education in Obstetrics and Gynecology objectives related to mature women's health. 

METHODS All accredited Ob/Gynecology residency programs in the United States were identified (N=276). In April, 
1994, a questionnaire was mailed to their program directors. Questions pertained to the setting in which mature women 
are seen, demographics of patients, the number of faculty members whose primary activity focus is on mature women, 
involvement in research and concordance with the Council on Resident Education in Obstetrics and Gynecology 
(CREOG) eoutadonal objectives for residents. 

RESULTS Fifty eight percent (160) of the programs surveyed responded to the questionnaire. Seventy seven percent 
of programs from the western stales returned their surveys as compared to 49% from the midwest, 52% from the 
northeast and 64% from the south. Large (^ 25 residents) programs were more likely to respond that smaller programs 
(69% vs. 55%). Thirty six percent of the respondent programs (N=160) claimed to have a mature women's center, 46% 
reported hav-ng mature women's health designated faculty and 3 1% indicated they were involved in mature women's 
health ongoing lesearch. The most common research topics included: osteoporosis, urinary incontinence, symptoms of 
-menopause, heat dj^^ease, cognitive function and sexual function. When asked if programs had included certain mature 
women's hulth CREOG objectives in their written cuiriculum, and if attainment of those objectives was mandatory, the 
residency directors responded as follows: 

CREOG Ohiective Written Curriculum Mandated Attainment 

Risks and Benefits of HRT 71% (1 14) 57% (91) 

Types &. Uses of Pessaries 62% (99) 38% (6 1 ) 

Prevention of Vascular Disease 50% (80) 26% (42) 

Modification of Pharmacologic 48% (77) 23% (37) 

Regimens due to Aging 
Respondents also assessed specific components in each of the above mentioned categories. 

CONCLUSION .With the population of women in the United States over the age of 45 increasing (approximately 1/3 
of all women ir 1991) and recognition that obstetrics and gynecology includes primary (generalist) health care for 
women, residency programs should provide appropriate didactic instruction and sufficient clinical experience in the 
management of problems and concerns of women in their post-reproductive age. Further efforts are needed to design and 
assess curncular, instructional, and evaluation systems which intend to satis^ these needs. 



AJd/MS suhmlisfNit tw 0«n« Mot. iyl.O^ M.1#.H. T.tt^tuum ta02> •taCtl* 

VV»«Mngten, O.C. 10201 

OEADUNtFORSUtMIStJON: RUDAY, 3yN§-«0rtttS 

•• -. •/ -.»;.;•:.:'• . :. • 21 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: mPLggNTlNG an INTEGRATED WO?^TrNVq rx-attw rTm??TrTnr^ 



Presenter: g^g^J^^^^-g^^' ^ Title: Director of Von.n's P..lrH 

i-ucia aec.< welss Program Manager of Women's Health 

Affiliation: M£2}ILI . Telephone: ^15) 8A2 •• 6A26 paX; g:5g43 -0253 

(Madical Scho&.'Pesidency Program) . 

•Women's Health' Education ProgrAi 
Address: 3300 Henry Ave Philadelphia. PA iqi?q 



City Zip Code 

Completing the Ab«rract Submission Form 

• Alf text should bs typed -vithin the perimffterj of The bo* shown. Ponts no smaller than 10 coints should be used. 
■ Organize the text of the abstract as follows: (t) objectives of the curriculum; 12) curriculum description; 
(35 problems encountered; and (4) results. 



Introduction: Since the early days of the women's movement, concerns have been 
raised aboJt the differential medicd care provided to women patients. In response to this, 
in 1993, tlic Medical College of Pennsylvania was awarded the first ever grant given by the 
Fund for the Improvement of Post Secondary Education (FIPSE) to integrate women's 
health into its problem-based learning track. 

Objective To redress the inequities of women's health care in medical education through 
the implementation of a women's health cuxriculum. 

Curricular Description: The Women's Health Education Program at the Medical 
College ot Permsylvania and Hahnemann University was established to improve health care* 
delivery to all women across the lifespan. This was accomplished by developing, 
implementing and evaluating a competency based curriculum for medical students, 
postgraduate trainees, physicians and other healthcare professionals. The goal of this 
curriculum is to teach the knowledge, skills and attitudes required to maintain women's 
health through disease prevention, diagnosis and treatment. A strong foundation and 
accommodating environment were constructed before the initiation of the women's health 
-curriculum. Instimtional support, such as policies for sexual harassment, were established 
to ready the educational climate for curricular reform. Existing currioilar materials in the 
problem basrd learning track were examined for gender bias and changes were made and 
reinforced through resource sessions, grand rounds, symposia and journal clubs. TTiese 
strategics were part of a multi-disciplinary approach to prevent marginalization of women's 
health issue;. 

Barriers to Implementation: Problems that we encountered in the past included 
1) implementing change in the status quo, 2) the lack of a knowledge base in women's 
health issues and 3) the lack of faculty and administrative support. 
Goals: We have begun to redress the inequities of women's health care so that we can 
improve health care delivery to all people. We must find additional incentives for faculty to 
become involved in the women's health curriculum and to continue their own research on 
women's health issues. 



Adar«;-is submiaftions to; £l«n« Rioa, M.D.. MS PH. Telephone: (202) 690-5884 

Office on Women's Health, QASH PAX: (202) 690-7172 

200 Independence Ave., N.W,, Room 730-B 
WasLiigton. D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. 1995 



^ 



22 



CULTURAL CCr^^PETENCE AND WOMtN S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION KORM 

P.■esonu^;^J^inii=l.y>1^.r^^S^^J^ Title: .A^^^jJsJ^ ^^iil=2.Ss>C 



Us: 



'Medicji Schoyl/Residoncy Prograni) 



Address: ^ • — 

City Zip Code 

Completing the Abstrcct Submission Form 

■ All toxt shouk) b.-j Typfd wiThm the perimeters of tt>e box shown. Fonts no smaller than 10 points should be used. 

■ Orgonize the text »f tho absfact as followj.: (1) objecuves of the curriculum; (2) curriculum description; 

(.1) problerTis cncounteiod; and (4) results 



I 
f 
I 






■■J* »■»■-=*■ 



APGO Quiz: A learning system for students of women's health care 

Magrane DM, Barclay MB, Gircrd P 
The APGO Quiz is a DOS based computerized self-learning program developed by the Testing 
and Technology Project of the Association for Professors of Gynecology and Obstetrics (APGO). 
Recognizing the need to develop and communicate knowledge, skills, and attitudes to promote 
excellence in women's health care, the Project has developed tools to assist students and 
in.structors. This simple Quiz formal also promotes use of computers by students and instructor 
and has an interdisciplinary and multi-institutional base of development and utilization. 

Each Quiz contains a pool of multiple-choice questions which are indexed to learning 
objectives. Responses arc linked to text which explains the correctness and background of the 
objective of the question. The original Quiz '93 contains six quizzes based on objectives for a 
clerkship in The obstetrics and gynecology. The most recently issued Quiz '95 focuses on a 
broad range of objectives in women's health care, including medical conditions seen more 
commonly in women, gynecologic problems, prevention and screening issues, and objectives 
relating to conlrciccption; abortion, and sexuality. Questions also address legal, ethical, and 
economic issues. Quiz '97 will add new questions based upon women's stages of life, from 
childhood to senescence. 

This curricular tool has been exceedingly well received by students of obstetrics and 
gynecology in the US and Canada. The software is being improved with extension to CD-ROM 
being considered. The members of the Testing and 1 echnology Project are eager to expand the 
use of this learning tool to all disciplines providing cure and instruction for women's health 



Adrlresr RubtniSiions to: Elenn Hios. M.D., M.S PH. Telephone; 1202) 690-5884 

Office on Womflns Health. OASH FAX: (202) 690-7172 

200 IndepenOcncc Ave., N.W., Boom 730-B 
Washmgion. O.C. 20201 

DEADLINE FOR SUBMISSION: PniDAV. JUME 30nDOO 2 3 



CULTURAL C0MPE7ENCS AND WOMEN'? HEALTH CURRICULA IN MEDICAL kuuwMiw« 

ABSTRACT SUBMISSION FORM 

bstraci TitJi: Utjlization of Advance-d Practice Nurses in Ambulatory OBGYN Clinics 
ros<nttr: ^^ebecca P. fIcAlister, M.D. j.^ Program Director, 03GYN Residency 

.ffiliation; Washington University Telephone: (31^ 362 4211 ^^^^ pi4^ 352^0049 

, Suite 1G306 One Barnes Plaza, St. Louis, 110 63110 



^dr«9«: ...^ ^__ 

' City Zip Coda 

oftifiitting the Abstract Submitston Penn 

AS text vhevM b« cvp«d witWn t.i« e«nfn«tcr» of «\t box shown, ^onts f* $mad«r than 1 poinw shocM be us«4. 
OrQatww tf« text a1 the •tvvact u fott»ws; 0) oe^ectives of tht eurrieOum; (21 evmculum 4«»Gnptton; 




Beginning in July 1993, we institued care by Advanced Practice Nurses (APN's) In the 
ambulatory OBGYN clinics at Washington University. Prior to this, all care had been 
by OBGYN rvssidents. Our objectives were to l)provide continuity of patient care for 
the broad spectrum of outpatient "well woman" care, 2) provide teaching to junidr 
OBGYN residents and medical students, 3) develop a practice mode! with 
collaberative practice between attendings, senior residents and physician extenders. 
Our curriculum included parralel clinics for APN's and OBGYN residents. APN's care 
for low risk obstetric patients and provide well woman GYN care. Medical students 
and R1 ard R2 OBGYN residents attend these clinics and learn physical exam skills 
. and counseling skills .from APN's. Residents' clinics include high risk obstetric 
patients, complicated GYN patients and patients that have been referred for 
consultation by APN's. Initially, some junior residents were uncomfortable having 
nurses as supervisors. Additionally, senior level residents needed to become familiar 
with the scooe of practice of APN's and their own role as consultants. After two years 
of operation, this curriculum is well accepted by patients and learners, and APN 
sessions are some of the most sought after clinics by students. Residents function 
smoothly in practice groups with APN's, and are becoming acquainted with the role of 
collaberative practices In the delivery of health care to women. 



uidr«ct suhmissiens :e: Elana Aiot. MJ>^ M.n,PM. Tsitpnons! 1202) f »0-SB8« 

OfhM on Wonwfs Hoolth. 0A5H FAX: (Z02i 69^7172 

ZOO lrd^0mnaaf»eM Av«^ N.W , A«Q<n 730-8 
Washinerert. O.C 20201 

DEAOUNE FOR SUBMISSION: FRIDAY, 3UM£-3drr995 



24 



1 



CULTURAL COM^FTENCE A.MD WOMEM'S HEALTH CURRICULA IN WEDICAL EDUCAltON 

ABSTRACT SUBMISSION FORM 
distract Title; InrlCTentlnq Curricu i sr Obisctives th Wrmpn'^ N^lth . 



I 



l^resenrer: Kathleen f^Intvre-Seltren. M.D. Title; Undergrad'jate MsdJcal Edu cation Ccmnlttee 

f Association of Professors of Cfcstetrics & 

Illation, gynecology, l^iversity of ?gh. Telephone: (412) &41--1^ FAX: (412) 64M133 

(Medical School/Residency Program) 

Idress: f^gee-Vfcrrcn's Hospital, 300 Ftelkgt StrPf?t. Pittsburgh. PA 15212. 



City Zip Code 

(T^pieting the Abstract Submission Form 

^ ill text should be typed within tne perimeters of the box shown. Ponts no imaKer than 10 points «houid b« used. 

i Ofoanite the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum dascriptioa* 

I (3) problems encountered; and (4) results. . 

i = = — 

Women's health Issues are defined by the U.S. Public Health Service as "those diseases 
or conditions wnich are unique to women, nnore prevalent or more serious in women, or tor 
which risk factors or Interventions are different in women." The Association of Professors 
of Obstetrics and Gynecology has developed a set of curricular objecti\/es for education 
in women's health at the undergraduate level. These objectives address preventive, 
reproductive, general medical, behavioral and psychosocial issues, with attenfcon to the 
Importance of women's role in family and community health. They are designed to cany 
through the entire cuniculum in an Integrated manner. These objectives are distinct in 
content and purpose from those we have developed and published relating spedficaliy to 
the obstetrics and gynecology cleri<shlp. Our overall goal is to explicitly Identify, for each 
health Issue, whether it is gender specific (i.e. different in men and women) or gender 
neutral. 

We have also addressed strategies for Implementation of these curricular objectives. 

These Include: , -u. * ^u r^ * 

• establishment of a multidiscipllnary committee or office responsible to the Dean to . 
coordinate cunicular review. Implementation and assessment 

'•" overviewHDf the cun^nt curriculum to assess strengths and weaknesses In teaching 
womei :'s health . u ^ 

• establishment of priorities for cumcular refomi, based on what issues artect women 
most . , 

• consideration of age/life cyde as a way to stmcture the curnculum , 

• emphasis within the established curriculum on awareness of the potential for 
pregnancy in all reproductive age women . , . j. j 

• development and utilization of multidisdplinary ambulatory models for providing and 
teaching women's health care ^ . ._ ..u ■ i 

• assessment of student evaluation modalities in temis of women s health issues, since 
testing drives cumculum 

• establishment of programs to "teach the teachers" • ^ ♦ ^ 

• outcomes analysis to demonstrate positive outcomes In response to an mtegratea 
approach 



Odress submissions to: Elena Rios. M.O.. MS.P.H Telephone; (202) 690-5884 

Office on Women s Health. GASH FAX; (202) 690-7172 

i^OO Independence Ave., N.W Room ^30-8 
V.'cshington. O.C 20201 

DEADLINE FOR SUBMISSION: fffl^A ^. JUNC 30, ' KI O G 



25 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEOJCAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: \^(f^t^'s t^ct-lH^ Fc4[^iU^f ^<- Bro^^ U■>^.V.t^s;•K 

Presenter. A^^ /^o^l-K/^ J^^ Title. hsSoC, Yf>A&M€(^ pf 7^e<i«U^C 



Affiliation: 



Address: 



'^ro^^ [X^^^u\^ Telephone: (^il 44-^ '0473, FAX: f^o/l444-^ 75 

(Mftdical School/Residency Program) 



J 



City Zip Code 

Compiexing the Abstract Submission Form 

• All text should be typed within th«: perfm^t-'-s o^ the box shown Fonrs no smaller fhan 10 points Should be used. 
■ Organise the text of the abstract as follows: (1) obiectives of the curriculum; U) curriculum description; 
131 problems encountered; and <41 results. ^^_^^ 



Background: Traditional internal medicine residency training does; not adequately acknowledge gender differences in 
disease presentation, diagnosis, or treatment. 

Ohiectivea : The Women's Health Fellowship at Rhode Island Hospital and Brown University School of Medicine 
wa.s devckqied in 1990 lo piuvide training for Board eligible or certified internists or family practitioners to develop 
clinical teaching and research expertise in women's health. 

Specific objectives include: (1) to develop expertise, including a knowledge base in clinical skills (e.g. colposcopy, 
endometrial biopsy) in the primary care of women, including General Internal Medicine, Obstetiics & Gynecology. 
Psychology and Sociodemographic issues (e.g. the effects of discrimination by gender or race). (2) to define an area 
of research in women's health, and (3) to develop innovative curricula and teaching skills women's health. 
Description: The Women'.s Health Fellowship was started in 1990 by linking the existing resources at Rhode Island 
Hospital. Women &. Infanu Hospital and Biown University School of Medicine. The components of the fellow.<;hip 
include; 'As a primary training site, a hospital-based muliidisciplinary gmup practice for women established in 
1987. staffed by general iniemisUi. psychologists, and gynecologists and primary care residents. 'Secondary clinical 
sites to enluiTKe clinical skills include; a mammography unit, a mcnopau:iC clinic, a breast clinic, and an 
osteoporosis imit at Rhode Island Hospital. Fellows participate in the teaching of women's healtJi didactics for die 
Medical Primary Care Unit, the women's health ambulatory topics in the Medical Primary Care residents, the 
women's health lecture series for Rhode Island Hospital. •Principles of study design and biostatistics are taught 
through the Departments of BiosiatLstics and Community Medicine at Brown University School of Medicine. 
•Fellows participate in the Teaching to Teach, Stanford Faculty Development Course for Teaching in the Division 
of General Internal Medicine at Rhode Island Hospital. •Fellows have access to resources at Brown University, 
including the Department of Community Medicine, the Deparinicni of Women's Studies. Center for Gerontology and 
. Health Servic^Jlescarch, Department of Bdiavioral Medicine at Miriam Hospital; the RI Health Departincnu and 
the RI Vanguard site of the Women's Health Initiative. 

Results to Date: The program has graduated two fellows who are both now employed at other institutions, (a) The 
first fellow left to set up her own Women's Health Practice in Southeastern MA. The second fellow is working at the 
Women's Health Practice. VAH University of Maryland where she is teaching women's health to residents. Other 
accomplishments stemming from this fellowship include: (1) formal women's health curriculum for the primary care 
intenial medicine residents: (2) 3 research abstracts wiili l publication ii> date; 5 chapters on the c^ire of fem^c 
patients in primary care text books; and (3) increased visibility of women's health at all levels of Brown University 
School of Medicine's curricula. 

Conclusion: The Women's Health Fellowship at Rhode Island Hospital and Brown University School of Medicine 
has t>een in existence ior 4 1/2 years and continues to train physicians who make significant contributions to medical 
education and research in women's health and to the primary care of all women. 



VMr..'. subm...ions to: Efna Rio^. M.O.. M.S.P.H. Telephone: (202) 690-5884 

Office or^ Women'r; Health. OASH FAX: <202) 690-7 1 72 

200 Independence Ave . N.W.. Room 730-B 
VA/ashington. D.C 20201 

DEADLINE FOR SUBMISSION: FRIDAT, JTJLT 21. 1^95 

26 



J Claudia Rutenberg, MS Progra.- Assiscar.c 

-^••■liaricr-: M^Hi r-qi rniT^go ^- "i "ei5C"C"e. 2' 5/9^1 ^-8 Si p, ."AX: 2 1 584 3 ■ 579-: 

>| .Mecical Sc.-ccl.=es;ca!-cv =-:g,'2rr; 




C::v T- r 



I 

i 



Clmplerirc the Abstract Submissic.- rcrrr, 

« All rax: srcuic :e ryrec vvi;.-ir :.-e zer: — i:i's zr :.-e :cx i.-c-v.-. =cr:s .-;c s.— ailer :.-an : Z zz:r:s s.-cujC :a jsac 

i^Wrgar.iie tre :ex: of ere acsrrac: as .'cilc-vs; ;ii cciec:;ves z'- :r.e z-r-.c-^i^^r-.; [2] c-.-.-rCwIur: zsszr.z::zr: 

jfc) rracier-.s anccuncar^c: arc i-i .'es^its^ 



I 
I 
I 

|l 

I'l 

M 

II 

II 



Introduction 

The Medical College of Pennsylvania and Hahnemann University (MCPHU) has implemented a systematic 
evaluation plan to assess the impact of a Women's Health Curriculum. The Curriculum and evaluations 
have been integrated into all four years of medical education with an emphasis upon the problem-based 
track. 

Objectives 

The goal of the women's health curriculum evaluation plan was to develop and implement multi-method 
measures and qualitative approaches to assessing the impact of the curriculum over a three year period. 
Evaluation Description 

Evaluation of knowledge, skills, and attitudes is an essential facet of curriculum development in women's 
health. We have evaluated knowledge, skills and attitudes as well as the women's health content of 
performance measures at MCPHU. Our assessments of knowledge and test content have included (i) a 
multiple choice diagnostic examination for the USMLE 1; (ii) essay and short answer examinations 
administered in the problem-based track; and, (iii) multiple choice examinations in the lecture-based track. 
Evaluations of skills have included (i) standardized patient exercises with parallel male and female cases; 
(ii) assessment of the number of women's health issues elicited by first-year students during their nine- 
week primary care practicum and, (iii) evaluation of clinical reasoning skills during Individual Process 
Assessments at the end of each problem-based teaching block. Evaluations of attitudes and perceptions 
of"the~program have involved (i) focus groups; (ii) in-depth interviews and, (iii) attitude surveys. 
Problems Encountered: The lack of an accepted definition of women's health, of validated measures, 
as well as faculty inexperience with women's health content posed problems when developing the 
evaluations. Moreover, faculty have found it pedagogically inappropriate to use the same measures (i.e. 
the same standardized patient cases) for the two tracks. 

Results: Initial results indicate an increasing number of women's health examination questions have been 
written by the faculty. Standardized patient exercises have been field tested/administered to third and 
fourth year students. The attitudes of male and females toward physicians differed when comparing 
problem-based and the Traditional Tracks. Focus groups indicate that problem-based-track students 
perceive that they are being well prepared in women's health while the Traditional track students find the 
information is not a main part of their learning. Other data are under analysis. 



Lrirass sv,=,~is3;crs Co; Siena Rics. M.O.. M.5.?.:-. Telecrcre; (2C2! cSa-533-i 

Orfica en V/on-.er.'s Heal:.". CASH FAX; (2CI; 53G-7172 

I2CG Indecenderca Ave., M.V/ . ["'cc— . 7 3C-5 
v/asnmgtcn. O.Z. XC2GI 



I 



DEADLIMS -OR SU5MISS1C.\: FRIDAY, JUiNE 30, 1995 



27 



II 

CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 



Absr.act "^itle 
Presenter 



ABSTRACT SUBMISSION FORM 

Women's Health Curriculum at Stanford 



M- T ++ Medical student IV, Coordinator (| 

uoDean ihcolette ^.^j^. ,,,q^^j^ , ^ Health Curriculum Committee 



Affiliation: Stanford University Telephone: 1 ^ 5)32 1 .55 91 fax: ( ) 

(Medical School/Residency Program) 

,^, OSA, M105 Stanford School of Medicine Stanford, CA 94305 
Address: ___J 



City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used 

■ Organize the lex', of the abstract as follows: (1) obiectives of the ci^rnculum: (2) curriculum descnotion: 

(3) problems encountered: and (4.) results. 



Objective: Recently, medical educators have begun to focus on the democratization of medical 
education. That is, facilitating the evolution of medicine to include a more accurate cross-section of thej 
population of the United States. Evidence of this encouraging trend is the current consensus that the| 
medical community has failed to address the major health needs of women, and the broad-based effort 
to develop curricula addressing women's health issues in the nation's medical schools. The paucity of- 
data about women is evident and must be addressed through more meticulous and inclusive research,! 
and the new data must be incorporated into training. Educators have proposed several models aimed 
at broadening medical training, including fellowships, residencies, specialties, and continuing medical 
education programs. I 

Curriculum Description: At Stanford we have developed a two week interdisciplinary clerkship in I 
women's health that crosses the traditional departmental structure of most medical schools. This clini- 
cal experience follows women's lives chronologically, from adolescence to old age. Segments on ■ 
prevention and health maintenance, and transitions and changes are well-integrated into the I 
curriculum. The format of the clerkship consists of didactic and instructional sessions in the morning, 
including several panel discussions, and clinical sessions in the afternoon. A particularly important part 
of the curriculum is an epidemiological seminar discussing the inclusiveness of biomedical research. I 
Clinical training is focused in a primary care setting but includes specialty experiences such as breast 'ii 
, cUpic, and an__3ftemoon-in-training with a local sexual assault resource team. || 

Problems Encountered: The largest obstacle to overcome was the debate over whether the ■ 
women's health should be stratified or integrated with the rest of the curriculum. Our joint student- p 
faculty task force participated in many hours of thoughtful discussion before making their li 
recommendation to develop a separate curriculum. Our next obstacle was time. Our most passionate '' 
task force members were predictably the most overextended. This was particularly true with faculty I 
members who serve as role models for minority groups, yet we felt that their participation was ^ 
essential to accomplish the level of inclusiveness we eventually attained. || 

Results: This new curriculum addresses health issues of women from all age, socioeconomic, race, ■ 
and ethnic groups, and sexual orientations. It focuses not only on issues limited to, or more prevalent m 
in women, but also issues common to both men and women in which practitioner education has been 
gender biased. It is our hope that the women's health curriculum, in conjunction with gynecology and ^ 
obstetrics clerkship, and the increased efforts of all our faculty to integrate women's health issues I 
throughout medical school training, will better address the health care needs of all women and || 
improve health care for all patients in the future. 



I 



Addrr^ss submissions to: 



Elena Rios, M.D.. M.S. PH. Telephone: (202) 690-5884 

Office on Women's Health, OASH FAX: (202)690-7172 

200 Independence Ave., N.VV., Room 730-B 
Washington, DC. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30, 1995 28 



I 
I 



CULTURAL COMPt'TENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

I ABSTRACT SUBMISSION FORM 

Detection Of Domestic Violence In Women Presenting 
bstract Title: To A County Hospital Emergency Room 



I 



eilritei: James J. Noc o n, M.D. Title: Third-Year Clerkship Director 

r 



Indiana University 317-630-6280 317-630-6524 

" " ■ " '"■' r I . 



ffi ftion; School of Medicine Telephone: ( ) FAX 

(Medical Schoo</ResidariCY Program) 



dr'-flss; Wishard Hospit a l, Ob/G v n, 1001 W. 10th St.. Indpls., IN 46202 

I City Zip Code 

ompleting the Abstract Stjbmission Form 

All text should be tvped withi.i xha p-jr;(T.e;2.'S of id-? bux shown Fonts no smaller than 10 points should bo used. 
Or Imzfl the text of tin abstract as follows: (1) obiectives of tna ciJrncLlum; (2) curriculum description; 
(3 irrjblems ancounrer^d; and I'll results. 



I 



1) Objectives of the curriculum: The clinical observation that many women who 
present for medical care after an alleged sexual assault may actually be victims of 
a larger spectrum of domestic violence has not been evaluated. This study was 
designed to teach medical students and residents the value of a questionnaire to 
assess the general prevalence of women at risk for domestic violence presenting 
to an emergency room for gynecologic care and to compare that group to those 
who present with a complaint of alleged sexual assault. 

2) Curriculum description: All women presenting to a large county hospital 
emergency room were given a questionnaire by the examining physician. The 
questionnaire asks about exposure to violent behavior, fear of the partner, 
coerced sexual conduct and knowledge of an assailant. Demographic 
characteristics, patterns of injury and the nature of prior emergency room visits 
were also examined. 

3) Problems encountered: The main problem was maintaining consistency in the 
use of the questionnaire. For example , while all patients who alleged sexual 
assault were offered the questionnaire, only about half of the patients presenting 
for gynecologic complaints were offerred it. 

4) Results: The questiormaire is effective in identifying a substantial number of 
patients (prevalence approximately 20%) at risk for domestic violence. 
Moreover, the study group presenting with an alleged sexual assault reported 
being a victim of domestic violence substantially more often (49% p < .01) than 
those who present for gynecologic complaints. This represents a significant new 
finding in defining a group of patients at risk for domestic violence. 



ddru»«i aubmistjoos to: Elena Rios, N/1.0.. M.S P.H. T«l«phane: (202) 690-S884 

Office on Women* Health. OASH FAX: (202) 690-7172 

200 InUependenue Ave., N.W.. Room 730-8 
Washington. D.C. 20201 



irum 

J 



\ 



DEADLINE FOR SUBMISSION: FRIDAY. JUNE-le. 1995 



29 



CULTURAL COMPeiENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
AbStraci Title: Gender Reconciliation in the Art of Healing 



Prescutfti 



James J. Nocon, M.D, 



Title: Third-Year Clerkshin Dirprrnr 



317-630-6524 
PAX: ( ) 



Indiana University 317-630-6280 
Affiliztioiv. School of Medicine Teiephone: { ) 

(Medical SchooJ/ResidancY Program) 

Addrsss: Wishard Hospital, Ob/Gyn, 1001 W. 10th Street, Indianapolis. IN A6202 

City Zip Coda 

Completing the Abstract Submission Form 

■ All text should be tvped wrthi.-i 'ho psrimetcs of ihe box sMown Fonts no ^.mader than 10 points should be used. 
• OrqaruzH the text of the abstract as follows: (l ) objectives of the curncuium; (2J curriculum description; 
(3) problems ancounreted; and l^i results. 



Title: Gender Reconciliation in the Art of Healing 

1) Objectives of the curriculum: To facilitate the growth of the medical student 
into the role of the healer with a particular emphasis on teaching men and 
women to find their own blocks to healing the opposite gender. 

2) Curriculum description: A series of six one hour seminars was designed to 
explore gender differences in the physidan-patient relationship by teaching 
facilitation techniques using a peer teaching model. In the seminars, men are 
encouraged to connect with their inner feminine archetype so that they may 
recognize the caring place within them rather than externalize this place as a 
feminine one and thereby fail to embrace its power to heal. Likewise, women are 
encouraged to identify the inner masculine so that they may be empowered to 
use this energy to remove their respective obstacles to the healing process. 
Another technique allows the student to recognize the presence and power of the 
human shadow (repressed experiences) to block the healing process. Typical 
questions asked include: What keeps the patient from healing? What purpose 
does the symptom serve? What prevents physicians from facing the truths 

p laced before them?- 

3) Problems encountered: Much of the facilitation work is Jimgian in nature and 
many of the medical students have little to no exposure to Jungian psychology. 
Moreover, there is a great reluctance to admit in a peer setting the feelings of fear 
and anger which serve as the most common obstacles to recognizing the "healing 
moment." 

4) Results: The response from the medical students to the seminars was 
overwhelmingly positive. They ranked getting beyond their ego to a new vision 
of the self as healer as their most valuable insight. They felt that this approach 
introduced the concept of soulfulness to medicine. 



Add/vw* nubmissions to: 



B^na Ri'os, M.O.. M.S P.H. 

Office en Women's Hc'ilth. CASH 

200 Independence Ave., N.W.. Room 730-8 

Washington, D.C. 20201 



Telephone: 
FAX: 



(2021 690-6884 
12021 690-7172 



DEADLINE FOR SUBMISSION: FRIDAY, JUNE-§e, 1995 



30 






I 
I 

r 



CULTURAL CCMPt'TENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Using Problem Based Learning To Detect and Change Gender 
bstract Title: Related Biases and Sexual Attitudes 



PresciUCi: James J. Noc o n, M.D. Title: Third-Year Clerkship Director 

Indiana University 317-630-6280 317-630-6524 

ffiliatioiv. School of Medicine Telephone: { ) FAX: ( ) 

{Medical Schod/ResidariCY Program) 



I 



tddrass; Wishard Hospi t al, Ob/Gyn, 1001 W. 10th St., Indpls., IN ^6202 
City Zip Coda 
Completing the Abstract Stjbmisslon Form 

I All text shfluld be tvpod withj.i '.ho pef;me:e."J of the box sMown Fonrs no smaller than 10 points should ba used. 
Orgaruzs the taxi of tin abstract as follovws: (l) ot:iec:ivss of tna curriculum; (2) curriculum description; 
f3) problems oncounreted; and I*) results. 



1) Objectives of the curriailum: Problem-based learning has been used as an 
effective method for teaching the academic core in OB/GYN clerkships. This 
study sought to determine if problem-based learning can also be used as an 
effective method to detect and change medical students' gender related biases 
and attitudes. 

2) Curriculum description: During the clerkship, five groups of students 
(n=130) were taught the core material using a problem-based learning 
method. Students in the first two groups (n=34) recieved no instruction on 
abortion issues and each of the last three groups (n=96) recieved a problem- 
based seminar on abortion. The effectiveness of this method was assessed by 
reviewing the students' comments on a short answer essay examination. 

3) Problems encountered: In another question designed to evaluate 
indications for lUD contraception, the majority of students failed to recognize 
that a married patient with a sexually transmitted disease may be in a non- 
irLonog.amous relationship. However, 8% of the female students and 5% of 
the male students asstimed the patient must have been unfaithful rather 
than her spouse. 

4) Results: More students answered that abortion was a patient's option in 
the groups that had the abortion seminar (36% vs 56%, p<0.05). Moreover, 
females included abortion as an option in greater numbers than males (74% 
vs. 49%, p<0.05). We concluded from these results that problem-based 
learning can be an effective tool for discovering biases that would be missed 
by more traditional teaching methods and that it can also be a useful tool for 
changing students' attitudes. 



i 

I 

II 

L 



Iddnnw aubmlsiions to: Gt\a Rio9, M.O.. M.S P.H. Telephone: (202) S90-6S84 

Office ^3l^ Women" j Health. OASH FAX: (2021 890.7172 

200 Indcpendance Ave.. N.W., Room 7308 
W«nmgton. D.C. 20201 



1 
I 



DEADUNE FOR SUBMISSION: FRIDAY, JUP*e40. 1995 



31 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
using Problem Based Learning To Teach The Detection and Management 
Abstract Title: -' 'domestic Violence 



Prescntei: James J. Noco n . M.D, 



Tills: Third Ypqr rip^v^h^-n n^-^Prr^r- 



Indiana University 

Affili2tion: School of Medicine 

(Medical Schooi/Residaricv Program) 



317-630-6280 ^.y. 317.-630-6524 
Telephone: ( ) FAX: f ) - 



fl 



Adrirsss; Wishard Memori a l Hospi t al, 100! W. 10th '^r.. Tndpic t\j aa-^O^ 

City Zip Code 

Completing the Abstract Submission Form 

■ All lext should b€ rypod withiii '.ho pofirneio.-s of the btj.t sricwn Fonts no smaller than 10 points should be used. 
• Orqamza the text of tha abstract as follows; (i) oDiectivss of :na curnculum; (2) curriculum description; 
(3) prt}blflms oncounrered: and l^i resuils. 



1) Objectives of the curriculuin: Problem-based learning has been used as an 
effective method for teaching the academic core in OB/GYN clerkships. This 
study attempts to determine if problem based learning can be used as an 
effective method to teach the detection and management of domestic violence. 

2) Curriculum description: In the first week of the clerkship, the students are 
given the case of a patient who presents with a history of vague pelvic pain, 
dysmenorrhea, and dyspareunia. The problem is presented in three parts. The 
first part emphasizes the necessity of a thorough history, physical examination 
and laboratory testing common to all female patients. Students are challenged to 
develop a plan of management for this patient. Part two reveals the typically 
unremarkable results of the physical exam and laboratory testing found in 
battered women. Part three reveals the lack of an organic etiology as evidenced 
in prior medical records and laparoscopy performed by other physicians. 
Immediately thereafter, a thorough discussion of the problems encountered in 
detection and management of domestic violer.ce occurs. The students are then 
given a simple patient questionnaire to help them identify the patient at risk for 
domestic violence. 

3) Problems encountered: Students are asked to formulate a differential 
diagnosis after part two and they uniformly include endometriosis or pelvic 
inflammatory disease as the etiologic factors. 

4) Results: Prior to this exercise, no student has ever identified an abused 
patient in the clinic setting. Students are now eagerly involved in the detection 
and management of domestic violence in their clinic assignments and identify 
such patients with increasing frequency. 



Adcirwn* submissions to: Stta R!os, M.O.. VI. S P.H. 

Office o»-» Women's He/ilU^. CASH 

200 Independence Ave., N.W.. Room 730-3 

Washington. D.C. 20201 



Telephone: 
FAX: 



(202) 690-6884 
(202) 890-7172 



DEADLINE FOR SUBMISSION: FRIDAY. JUW&-§fl, 1995 



32 



I 



CULTURAL COMPETENCE AND WOMEM'S HEALTH CURRiCULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: homophobia obstructs the provision of quality health care for lesbians. 



Prp-jentef KaTHERINE A. O'Hanlan, M.D. 

presenter. . f.a.c.o.q., fa.c.s. 

Associate Director, Gynecologic Cancer Service 

Affiliation: department of gynecology and obstetrics - FAX: I \ 

STANFORD UNIVERSITY MEDICAL CENTER "" " . ^ 

STANFORD. CALIFORNIA 94305-5317 
Paufrj Une Fax Academic Ofp.cc 

Address- C^J 5) 723-5502 (415)723-7737 (415)723-8585 

' "^ E-mail: HF.KAO@Forsyihe.Stanford.Edu 



^^^^ CliY ' Zip Cede 

Completing uie MC/ mMci ftugiimaion rur r ri 

• AH reset shoufd t>« typ^d within the perimeters of the bqx shown. Fonts no smaJJar than 10 ootrtts Should be used. 
■ O/gaiti/e the taxt cf tt\t abstract as follows: (1> objectives o* tho curficu'um; (21 euiT»culum deacnption: 
<3lprob<ems encountered; and (4) result*. 



Homophobia obstructs the provision of quality health care for gay men and lesbians. 
O'Hanlan, Eatherine A., Division of Gynecologic Oncology, Stnaford University, Stanford 
CA 94305-5317 

Homophobia, the antipathy or disdain for gay men and lesbians, is a widespread response 
to an unfamiliar and previously hidden segment of society. There is evidence that medical 
practitioners are not immune to having learned this pervasive societal prejudice and may 
unintentionally reflect disdain for homosexuals when they present as patients. Survey evidence 
will be presented which suggests that gay male and lesbian patients perceive this disdain and are 
alienated from the medical system, reducing their utilization of standard screening modalities, 
potentially resulting in higher morbidity and mortahty from cancers and heart disease. 

Surveys of the lesbian community assessing health risk profiles confum the need for real 
scientific inquuy. A tentative health profile of lesbians will be presented which reveals that they 
are more hkely to be nulliparous or oligoparous, possibly having a higher body mass index, using 
more tobacco and alcohol, and are less likely to contract gynecologic infections and sexually 
transmitted diseases. If this profile is correct, then lesbians would be at higher risk for breast, 
uterine, ovarian and colon cancers as well as heart disease and stroke. Gay males are 
theoretically at increased risk of lung, colon and gastric cancers.as well as heart disease. 

Research suggests that diversity of sexual orientation appears to result variably from 
genetic influences, embryologic hormones, and personal experiences without any associated 
sociopathology. Thus, being lesbianor gay is not genetically or biologically hazardous, but risk 
factors are conferred through "homophobic fallout." Remedies for the profound medical and 
psychological effects of such disdain on the developing self-concept will focus on youth as well 
as the adult? who recognize within themselves a same-sex orientation. The process of 
homophobia-the socialization of heterosexuals against homosexuals and concomitant 
conditioning of gays and lesbians against themselves-must be recognized by physicians as a 
legitimate health hazard. Solutions to homophobia in medical practice are discussed which would 
improve access to care as well as the quality of care provided to g^y men and lesbians and 
favorably impart the health and quality of life of this population. 



VMwi submiMiona lo: Elena fljos. M.O., M.S.P.H. Telephone: (202) 630-5884 

Of.:oe on Women'« Health. OASH PAX: <202) 690-7172 

200 irvdeoendence Ave., N.W., Room 730-e 
Washington, O.C. 20201 33 



f 



CULTURAL COMPSTEMCE AND WOM£N'? HEALTH CURftlCUU W MEDICAL tuuu«nwiV 

ABSTPACT SUBMISSION PORM 






iA^orM^ln'j ^tT/^/^'cj^s^ 



fM«dicaf SchooJ/l^afid^ncr Program) 

tity Tie Cod« 

:omp/ating the Abstract Submi»s«jn Form 

I Afl text *h«o«d ba tvp«d witNn u^ penmaicrs of the box shdwft. Fonts w smaflir than 10 DOi«t sho*ii ^ laa.^ 
' ^r«, th* t«xt cf The .bstract « fo^tows: (1} oojecove* c/ th« cgrricutum; K2) cumcuhw dHS^ 



(3) &fefaiams tficowtft fedt and (*) r«*uftt. 



NURSE-RESIDENT PRECEPTOR PROGRAM TO FOSTER COLLABORATIVE WORKING 
RELATIONSHIPS. S. OXeary. J. Musich, William Beaumont Hospital, Royal Oak. MI 48073 

Objectives: To improve the intem's and the nurses' understanding of each other's rc^es through active participation, in 

order to foster collaborative working cnvironraent 

Curriculum Description: E*rior to beginning the academic year each Ob/Gyn intern is paired with a labor and delivery nun« 

for an eight-hour shift In the same day he/she it, paired with either a gynecology or postpartum nurse for an additional fo 

hour shift The intem's role is that of nurse's aide both obscn'iag and participating in her daily activities. The intern is not 

identified to the patients as physicians. Later in the year the nurses follow an intern through an entire 36-faour call shiA 

observing and assisting the intern. Our purpose is to allow nurses and interns to "walk in each other's shoes" and hence be 

exposed to the unique pressures and responsibilities inherent in each job. Upon completion of the program a debriefing . 

session is held in which all participants evaluate the program. 

ProWeW-^JEncoGntgrpdr Initiaiiy; negative attitudes were the biggest obstacle wc met The interns weI^ anxious to begin 

their clinical work and the nurses were hesitant about spending a 36 hour shift at the hospital. Reimbursement of the nurses 

I 
hours was also a problem which was overcome by compensating the nui^es with days off. Finally, objective evaluation of 

the program is difficult because of the multiple factor? involved in establishing relationships between nurse rind physician. 

Results: Although objective data is not available to determine if participation in die program improved relationships, both 

nurses and interns stated thai the program successtuliy allowed them to gain a better appreciation of each other's roles azkt 

felt this allowed for better working rcladonships. The intem's uniforaily determined that the program jave them a imique 

p ers p ective in which to begin the year. Nurses reported improved relationships with the residents aixl directly attribute thi 

to having participated in the program. 



idr«t» tubmissions to; Sena Rio«, M.O.. M.S.P.H. T«tephoft»: 

OffUs« on WomarCA Heafth. ©ASM f AXi 
200 ln<»«p*o<j«nc* Av«^ N.W , Room 730-6 
WasWr^On. O.C. 20201 



<202> 690'5884 
<202)690>7t72 



DEAOUNE FOR SUBMISSION: FRIDAY, 3 UNC 3e> 1985 



34 



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ABSTRACT SUBMISSION =GR^v^ 
DESIGNING A PRIMARY CARE CURRICULUK FOR OB/GYN RESIDENTS: 
OStracC Title: _ RE SULTS OF A NEEDS ASSESSMENT. 



iresenter: 
Affiliation: 

I 

Address: _ 



Kelly S. Parsey, M.D. Titfe' Women's Health Fellow 



Durham V/u^lC/ Duke roi.phnnp- (919> 286.6936 FAX: ^19)416.5836 



(Medical Schoal/ResidencY Program) 
508 Fulton St. (152) Durham, N.C. 27705 



I 



City Zip Code 



omDieting the Abstract Submission Form ,o • ^ ,.. .. 

. All text .hculd be rvped w.h.n rh. perfmece^s of the box shown. Fon« no .m.ll.r mamO pcnts shc.ld be used. 
f Organic the text d rh« ab^ract « foNow.: m ob,ect>ve. of the curriculum: (2; cu-r,culum de.cnpt,cn; 
.1 (3) probl ems encour.te.ed; and (4-1 results. 

f — — ^ 

f Objectives of the curriculum: Supported by the American College of Obstetricians and Gynecologists' 
(ACOG) guidelines for training OB/GYN residents in primary care, we proposed a curriculum that would 
both train OB/GYN interns in non-gynecologic primary care as well as expose this group to a 
fl multidisciplinary approach to women's health. 



f 



Curriculum description: We have designed a 6 week rotation for OB/GYN interns which includes the 

r following clinicai time structure: 30% in non-gynecologic clinics, such as General Medicine, Breast, and 
Mental Health Clinics; 40% incorporating comprehensive health care in a gynecologic clinic setting; 20% in 
,^ didactic conferences, such as OB/GYN and Internal Medicine grand rounds. Ambulatory Care Morning 
Report, and a Critical Appraisal of the literature conference. Finally, 10% of the time is spent on individual 
instruction by the Women's Health Fellow. This covers common problems encountered in the out-patient 
medical care of women. 

Problems encountered: A problem encountered in the development of the curriculum for the individual 
instruction sessions was in identifying the medical topics that needed emphasis. We requested that the 
OB/GYN housestaff and faculty complete a needs assessment survey ^^ch utilized a 10-point level of 
comfort scale for I't areas of primary care identified by the ACOG guidelines. We designated a comfort 
score 6r5 or less as indicating an area in need of further training. Our survey found that OB/GYNs needed 
further training in the following areas: treatment of hypertension (100%), treatment of non-gestation al 
diabetes (100%), screening for depression (82%), screening for skin cancer (71%), treatment of 
musculoskeletal complaints (68%X and immunization requirements (61%). However, we found that few 
OB/GYNs needed trair^ing in these areas: screening for domestic violence (25%), evaluating abdominal pain 
(7%), and counseling about safe sex practices (0%). 

Results: Based on these responses, we developed a curriculum for the individual instruction sessions to 
emphasize six areas: hypertension, musculoskeletal complaints, non-gestational diabetes, immunization 
requirements, depression and skin cancer screening. 



=, D- >u.nM<;PH TeJcphore: <202) 690-5884 

vldre?s submissions to: Bona Rios. M.O.. M.5.P.M. (202)690-7172 

Office on Women'.-i Health, CASH FAX. «-iw^' ^ 
200 Independence Ave.. N.W., Boom 730-8 
Washington. D.C. 20201 

DEADLINE FOR SUBMISSION: ntDBAY, JTILT 21. 1995 ' 



I 



r 

CULTURAL COMPETENCE AND WOMEN'? HEALTH CURRICULA IN MEDICAL EDUCATION | 

ABSTRACT SUBMISSION FORM - 

Abicrac: Title: Hrogram in Female Clinical Anatony: A Model for Incorporating Women's 

Health into the Basic Sciences 
Pres-ir.cer: Kathrvn E. Peek. Ph.D. Title: D irector, Program in Female Clinical An a^ im 



Affiliation: University of Texas-Houst ofTelephone: (713 745-2143 FAX: (713 792-5795 

{MediCdl School/Residency Program) 



Addross: 6431 Fannin, Ste. 7.046 Houston, TX 77030 

City Zip Code 

Completing the Abstract Submission Form 

■ All Text snouid be typed within the penmeters of the box shown. Fonts fio smaller than 10 points should be used, 

■ Organize the text of the abstract as follows: (1) objectives of the cxjrnculum; (2) curhcuium description; 

«3) problems encoi-ntced: and (4) results. I 



f 

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Background. In fcraditioual medical education, the normative human is a 70-kg male. Anatomy texts and 
instructional materials generally portray the human body with distinctly masculine traits. Differential female 
characteristics ^T^ described only in sections dealing" with reproductive anatomy. Hence, medical students learn 
that female bodies are like male bodies except in reproductive structure and function. 

Objectives. The new Program in Female Clinical Anatomy at the University of Texas-Houston Medical School 
heis been designed to expand the fund of knowledge about normal female biology and commtinicate the growing 
base of information to medical students, researchers, surgeons, and physicians. Specific aims of the Program 
include: 1) augmenting the existing medical curriculum, to include focused instruction about unique 
characteristics of the female body; 2) identifying gaps in knowledge and initiating collaborative investigations 
about normal female biology; and 3) increasing research relevant to women's health by training and assisting 
scientists to include gender-specific investigations in their research sttidies. 

Descziptiofiu Although several institutions have initiated medical education programs in women's health, ours 
is one of the first to be based in the basic biomedical sciences. Therefore, we are able to influence students very 
early in their medical training, when they are learning the basic concepts that underlie cTim'ral medical practice. 
The components of the Progr a m include: 

• A laboratory-?)a3ed instructional module in gynecological anatomy incorporated into the Gross Anatomy 
course. The module leads students through a programmed xmit about female pelvic anatomy, utilizing prosected 
and plastinated cadavor materials. Modules about female-specific structure throughout the body have also been 
incorporated into tiie AJJAM.^** (Animated Dissection of Anatomy for Medicine) instructionsil software 
program. Thus, medical students receive focused trainiag about differential fismale anatomy during their first 
semester of medical schooL 

• A training resotirce for researchers who want to study female physiology. The Program ofiers teaching and 
training in comparative female biology to assist researchers in adapting and developing basic-science research 
models to include female animals. 

• A database of gender-specific anatomic information. Plans are tinderway to capture and catalog the raw 
images from the Visible Human. Project, made available via the internet by the National Academy of Medidne. 
These images will be digitized, labeled, and pubUcized to interested biomedical personnel 

Results to Date The Program has been in existence for only e few months. Early experience suggests good 
acceptance by medical faculiy and students alike. AccompHshments so far include: 

• start-t^ grant support fiom the Women's Fund for HER (Health, Education, and Research); 

• four coU^wrative research prtjjects in progress; 

• summer researti. tmining for a first-year medical student; 

• participation in the development and facilitation of Problem Based Learning case studies. 

Concliz^on. The Program in Female Clinical Anatomy promises to influence medical education by establishing 
a model for incorporating women's health into the basic-sdence curriculum. 



Ad->rprs submissions to: Elena Rios, M.D., M.S.P.H. Tdephone: f202) 690-5884. 

Office on Women s Health. CASH FAX: (2021 690-7172 

200 Independance Ave.. N.W., Room 730-B 
Washington. D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. 1995 _ . 

36 



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CULTURAL C0MPE7ENCH AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

I 



I 



ABSTRACT SUBMISSION FORM 

bSiraCT Title: Imoact of Clerkship Requirement on Use of GAI 



Presenter: Sharon T. Phelan, M.D. Title: Associate Professor & Clerkship Director 



I 

dress: ^Ol South 2Cth Street, Suite 604 Birmingham, Alabama 35233-2023 



ff illation: University of Alabama at Birmingh aygiaphone; ^205^ 934-J872 FAX; P^ ) ^^"^^^ 

(M«4tc«( Schoci/Reaidtncy Progrim) 



i 



City Zip Code 

IpmpictinQ the Abstract Submission Form 

§AII text ihould be typed /within The perimeters o^ the box shown. Fonts no smaWer than 10 points should b« used. 
■ Orgeniza the text of the ibstract is foliowr. H) obj«ctivei of the eufriculum; (2) curriculum description; 
3) problems encountered; and (4} results. 



i 



Impact of Clerkship Requirement on Use of GAI 

Sharon T. Phelan. M.D., Eta S. Berner, Ed.D., James R.Jackson, Ph.D. 

As clinical experience moves into the ambulatory setting, it is more difficult to give students the opportunity 
to evaluate an undiagnosed patient complaint This can be especially true in Ob-Gyn where it is often 
difficult to get madical students into private clinics. To provide this experience the students were instructed 
on a decision support program (QMR) that had 24 specific cases that we designed for their use. The 
diagnoses ranged from classic Ob/Gyn (amenorrhea) to medical issues (hypothyroid), surgical 
emergencies (appendicitis), psychiatric problems (depression) and public health issues (secondary 
syphilis), in addition computer programs on fetal monitoring and other relevant topics from ACOG were 
made available on three student-dedicated computers and their use was strongly encouraged. 

The 1 992-1 993 academic year (Group 1) were encouraged, but not required to do the cases, the 1 993-1 994 
academic year (Group II) were required to complete at least 4 assigned cases. Both years had a formal 
program instruction session early in the clerkship and dedicated time to work on the computers. At the 
end of each clerkship in Group 11 there was a small group session to discuss 4-6 randomly chosen cases 
with the student assigned the case role playing the patient and providing the responses the computer had 
givan. - _ 

The students completed an evaluation on the entire computer experience. The resulting sample of 181 
students represented > 80% of each group. Having the required cases and group follow-up led to more 
students u^r ] ±e computer and overall more hours spent usinq the computer , especially QMR. Although 
this see* "tuitively obvious, there was the risk that the students would just shift their time allocation for 
compu a rather than increase overall time. 

Medical students tend to invest time only in those activities that are evaluated or that they feel are useful. 
Learning a new program/skill can be very time consuming. Requiring the use of QMR In a structured 
program, incretsod the number of students using the computers significantly and the time spent on the 
computers per student It is clear that simply making CAl available is not enough to ensure its use by 
medical students, even when dedicated time and computers are provided. The educational activity should 
also be generalizable. The students have found this useful enough that the institution is exploring getting 
this or a similar decision support program on a main frame to be accessed by students on all services not 
just Ob/Gyn. 



|ire>^ eubmiieions to: Bene FUos, M.D.. M.S.P.H. Telephone: (202) 680-5894 

Of7iD« an Wamen'ii HMlth. CASH FAX: (202)890*7172 

SO l«idap«nd*nes Av«.. N.W.. Heom 730-8 
Weshington. Q.C. 20201 

DEADLINE FOR SUBMISStON: lUDAT, JULY 21. 1^95 - 



37 



CULTURAL C0.V5PETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: Tltrlng of Pelvlc Exam Instruction During Medical School 

Presenter: Sharor T. Phelan, M.D. Title; Associate Professor & Clerkship Director 

Affiliation: Dniverslt y o f Aiabaina at BiTmingh aiTelflDhone: I ^0^ 934-7872 pAX; ( 205) 934-2258 

(M*dieal School/Residtncy Progr«m} 

Address: 301 South 20th Street, Suite 604 Birmingham. Alabama 35233-2023 

City Zip Code 

ComplatinQ the Abstract Submlseion Form 

■ All text should bt typed within tH« perimeters o' the box shown. Ponts no smaller than 10 points should b« used. 

■ Org«n<2a th« text of the abstract is follows: ID objoctives of Xttd eu/rlculum; {2} curriculum detehpiion; 
(31 problems encountcrBd: snd (41 rssuits. 



Timing of Pelvic Exam Instruction During Medical School 
Sharon T. Pheian, M.D. 

The teaching of physical exam techniques has ccnnnonly been accomplished in many 
ways and times in the curriculum. More institutions with LCME encouragement are 
starting courses in the second year of medical school to prepare the student for 
the clinical clerkships. There is one possible exception - the pelvic exiun. 

At UAB the second year class participates in a year long Introduction to Clinical 
Medicine (ICM) that includes pelvic exam instruction during one week in the 
spring. To provide 180 students the opportunity to observe three pelvic exams 
and to pej."form one during a single week is challenging. Since gynecologic 
teaching associates are used, the session is not done during clinic. Thus, there 
are logistics Tor faculty instructors, GTA's, nursing support, exam rooms and 
equipment to be arranged. The faculty expressed a desire to shift this 
instruction to the beginning of each Ob/Gyn clerkship when there would be smaller 
numbers of students and immediate reenforcement of the technique in the clinic 
setting. Prior to such a change, the fourth year class was surveyed to determine 
when they fel. the pelvic exam should be taught. 



The students were evenly divided 51% to 49% regr.rding when to teach the exam. 
When the data is reviewed by individual rotations it showed that students who 
started Ob/Gyn later in the third year were almost twice as likely to want the 
instruction then rather than in the second year. Yet the later in the year a 
student did the Ob/Gyn Clerkship, the more likely the student had already done 
pelvics on other clinical services, commonly family medicine. Since the two 
preference groups were the same regarding experience with pelvics prior to the 
clerkships, this did not seem to be a decisive influence. 

The most compelling point for continuing the teaching in the second year were the 
observations made by the students. "It is iii5>ortant for students to realize that 
it is part of a woman's health maintenance, not just a part of Ob/Gyn". We need 
to enforce, the idea that women's health care is an issue for all physicians and 
not just Ob/Gyns. Teaching the pelvic only with the clerkship tends to send the 
wrong message. For this reason in particular, we at DAB continue to teach the 
pelvic exam during the sophomore ICM course in the spring. 



\0tirft5'; submiialorw to: Eltni Rios. M.D., M.S.P.H, Ttlephen«: (202) 690<&884 

OHiea ort Wom«n')i Health. OASH FAX: (202) 600*7172 

200 indopar>d«noa Ava.. N.W.. Room 730-8 
W->shington, O-C 20201 ^Q 

DEADLINE FOR SUBMISSION: niI))A7, JUL! 21, 1^5 ' 



f 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA iN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 



Ibsiract Title: Dcvelopiny and Imp | Pment j ng P WAinr»n'« Vtn^lth rurrwiiliim (mm n C d i n n i ml it^ Pi ] n» .. f JLi 
Jancx Preglcr, M.D.; Jodi Friedman, M.D.; 
Wesenter: and Mit^i Krockovcr,M,n. ' Title: - 

fflliatlon: UCLA School of Medicine Telephone: (. ) ^1fU79il,08in '^AX: ( 3 lb 79r9 H 2 4 

(Medical School/RetidBncY ProgrBml 

Department of Internal Medicine, DiviiiioD of General Internal Med 



1 
I 



[vddress: 



City Zip Code 

fampleting the Abstract Submission Fofm . .« ^ •-. ►. j 

Mx^.x .hLd b- typed within the p.r.m«t.r3 of the bax shown. Fonts no sm.f.er th-n 10 po.nts should b. u«d. 
Orpanire the text of the abstract « follow^.: (1) abjectlvw cf th« curnculum; (2) curr.cuiom deacr.ption: 
13 » problemi ©ncountared; and (4) results. 




"De^-eloping and Impiemeniiug a Women's Health Curriculum from a Gcneralist Perspecti\'e" Janci 
Prcgler M.D., Assistant Clinical Professor. Jodi Friedman, M.D., Assistant Clinical Professor and 
Associate Program Director, Internal Medicine; Mitzi Krockover, MD., Assistant Cliaiical Professor and 



Director, In« Cantor-UCLA Women's Health 



Center, Division of General Internal Medicine, Department 



of MedictLc, Universitj- of California, Los Angeles. 

There is a growing consensus that traditional medical education at both tlie undergraduate and graduate 
level has not adequately prepared generalists io care for women. To begin to address this issue, goals and 
objectives for women's health education for g^eneralists at the medical school, residenc}', and fellowship 
level have been developed. Implementation has included a mulii-site. multi-disciplinary approach which 
has empltasized tlie role of the generalist as provider of the majority of care and as coordinator of the 
health care team. Case-based learning modules at the medical student and resident level have been used 
to demonstrate the impaa of gender on the evaluation and treatment of a variety of clinical conditions. 
Specific emphasis has been placed on important aspects of anatomy, physiology, and psychosocial 
condiiions of women. -Medical students and residents are also exposed to concepts of women's health 
related issues on such topics as critical review of the literature and managed care. 



Addrtiits submissions to: Clans R<os, M.O.. M.S. P.M. 

OfficB on Woment Health, OASH 

200 lodepandsnca Awa N.W. Roorn 730-8 

Washingion, O.C 2020 1 



Telephone: 
FAX. 



(2021 690-5884 
J202) 690-7172 



DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. T99S 



39 



CUl rURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Ab3Lii-r. ..tie: The Wome n's Health T rack: A Model for Training Internal Medicine Residp.n r.. 
P : c s rt r ^ '■; , : Mich el l e M. R ob ert s_,. 'M; JI. "'' ■ ^ ' ^ ^ Assistant Professor of Medicine 

Affiliafoir University of Pittsburgh Telephone: (412648 -9770 FAX: (41 )fSAfi -lOLi 

iWeaical School Residency Program) 
additional authors: Frank J. Kroboth, M.D. and George M. Bernier, Jr., M.D. 

Addre-,.-^; E-1140 Biomedical Science Tower Pittsburgh PA 15261 

City Zip Code 

Completing the Abstract Submission Form 

■ All text ^nouiG be typed witl"iir. tne periaieters of tiie box shown. Fonts no smaller than 10 points should be used 

■ Organize the text of the abstract as foiiows: (1) objectives of the curnculum; (2) curriculum description; 



1 



The current practice of ambulatory internal medicine involves management issues in women's 

health which are not often taught in standard residency programs. The University of Pittsburgh Medical 

Center has initiated a pilot program, the Women's Health Track, to provide internal medicine residents with 

jthe opportunity to develop clinical skills and expertise in aspects of health that are unique to women. 

•Incorporated into an established internal medicine residency, this program combines areas of obstetrics, 

jgynecology, psychiatry, and adolescent medicine into a multidisciplinary curriculum that prepares internists 

p provide a variety of routine health care and screening services to women. The program is structured 

jas a series of electives spread throughout the three years of an internal medicine residency with both 

inpatient and ambulatory care experiences. The first year includes a one month full-time rotation in the 

Emergency Department of a large urban obstetrics and gynecology hospital. Interns also spend one-half 

jday every other week for 12 months in an urgent care clinic for evaluation of gynecologic problems. The 

'second year includes a one month inpatient rotation on a women's psychiatric unit which provides both 

jpiedical and psychiatric care. An additional one month block is spent in an ambulatory care elective that 

'includes subspecialty clinics in osteoporosis, reproductive endocrinology, Gl problems in women, 

Ijurogynecology, adolescent medicine-contraception and cervical disease. During the second year, 

j residents spend one half day every other week for 6 months in a clinic which provides continuity care for 

pnxiety, depression, and postpartum related psychiatric disorders. One half day every other week for the 

remaining 6 months is spent in breast cancer clinic; a multidisciplinary clinic staffed by oncologists, 

radiologists, and surgeons. Third year residents spend one month on medical complications of pregnancy, 

^hich includes medical consultations and outpatient management of high risk obstetric patients. They also 

fpend one month in gynecology clinic at Student Health Services of the University of Pittsburgh. The third 
ear ambulatory care experience is based in a mature women's clinic, which focuses on medical and 
gynecologic problems of women over age 55. A monthly journal club meets during each year and provides 
B forum for discussion of specific topics not covered in rotations. Overall, the administration in both the 
(School of Medicine and the Department of Medicine have been extremely supportive of the Women's 
Health Track. The major problems encountered have been scheduling conflicts and personnel changes. 
There is no external funding source. The program is currently in its third year of existence with three 
-esidents at the PGY 1 and 2 levels and two at PGY 3. One male resident entered the program in his 
second year and recently completed his residency. He is now doing a year of locum tenens and said the 
ii/Vomen's Health Track trained him to provide better care for women patients. 



Al.lrns. -'ibinss.ons tc Eiena Rds M D. M.S PH. Telephone: (202) 690-58S-i 

Cff'co on Women's Health. CASH f^AX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-8 
V.asntngtcn. O.f. 2C201 



DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 ^0 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Developr.ent and Implementation of a Women's Health Curriculum for Medical 

AK,.+,-.^» T,t\a- Students 

Adstraci Utie. . _ . Assoc. Frof. ot Clinical Obstetrics & Gyn; 

Patricia A. Robertson, M.D. y-.,.. Dir. , Ob/Gyn Medical Student Teaching Progri 
Presenter: ' '^'^' —■ 

Affiliation: Univ. of CA, San Francisco Telephone: f>15) A76- 1824 FAX: ( 41^5 476-1811 

(Medicai School/Residency Program! 

UCSF Dept. of Ob/Gyn & R.S., Box 0132, San Francisco, CA 94143-0132 
Address: 



City Zip Code 

Completing the Abstract Submission Form 

■ All text should be rvped witnin the perimeters of the box shown. Fonts no smaV.er than 10 points should be used. 
• Organize the text of the abstract as follows; 11) objectives of the curriculum; (2) curriculum description; 



(3) problems encountered; and 14) results. 



OBJECTIVES OF THE CURRICULUM 

1) To teach basic gynecology within the context of an interdisciplinary women's health curricula for 
second-year medical students (n=150) in the Introduction to Clinical Medicine Course 

2) To sensitize the medical students about psychosocial issues of women's health 

CURRICULUM DESCRIPTION (Total Hours = 16) 

1) Introductory Lecture (1 hour) 

2) Progressive Disclosure Cases (2 hours each x 5 = 10 hours) (groups of 8 students and 1 faculty) 

a) vaginitis 

b) pelvic pain 

c) menopause 

d) urinary incontinence 

e) abnormal vaginal bleeding 

3) Gynecologic History Taking (2 hours) (groups of 6 students with 1 faculty) 

a ) unplanned pregnancy 

b) contraception 

c) postmenopausal bleeding 

4) Pelvic Model Session (2 hours) (groups of 4 students, 1 faculty, and 1 gynecologic teaching associate) 

a ) breast exam 

b) pelvic exam 

c) rectovaginal exam 

5) Final Examination (1 hour) 

PROBLEMS ENCOUNTERED 

1) Complex administration of the course due to the large number of faculty required (both full-time 

academic and volunteer clinical faculty utilized with an hour of faculty training prior to the small 

groups). 

RESULTS 

1) The course was well accepted as a multi-disciplinary case-based method curriculum. Overall, the 
students rated the course on a scale of 1 - 10 (l=inadequate, 10=outstanding), as 8.34 (mean). 

2) Students who had expxDSure to both primary care faculty and Ob-Gyn faculty preferred that the 
majority of the progressive disclosure cases be taught by Ob-Gyn faculty, but stated that at least one of 
the cases should be taught by faculty from Family Medicine or Internal Medicine. 



Adorcis submiss;ons to: Elena flios. M D , M.S.P H. Telephone; (202) 690-5884 

OfTice on Women's Health. OASH FAX: t202t 690-7 1 72 

200 inflependenoe Ave., N W.. Room 730-8 
Wasriington, C. 20201 

DEADLINE FOR SUBMISSION; Friday, August 4, 1995 ^^ 



CULTURAL COrwIPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION p 

ABSTRACT SUBMISSION FORM 
Student Evaluation of an Assigned Day in an Abortion Clinic in the j— 

Abstract Title; Junior Clerkship in Obstetrics and Gynecology t 

Associate Prof, of Clinical Obstetrics & 
p^ Patricia A. Pvobertson, M.D. Title; Gynecology; Dir., Ob/Gyn Medical Student 

Teaching Program | 

Affiliation: Univ. of CA, San Francisco Telephone: f^^ A76. 1824 p^X: I ^^^ A7.6-1811 

(Medical School/Residency Program) 

UCSF, Dent, of Ob/Gyn & R.S., Box 0132, San Francisco, CA 94143-0132 ' 

Address: 

City Zip Code 

Completing the Abstract Submission Form 1 

■ All text snouW be typed within the pefimeters of the box shown. Fonts no smaller than 10 points should be used. f 

• Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and l4) results. l 



OBJECTIVES OF THE CURRICULUM 

1) Education about the procedure of first trimester abortion t 

2) Observation of the counseling process for women with unplanned pregnancies ' 

3) Experience in performing pelvic exams in the first trimester to increase sensitivity in detecting pelvic 
masses 

CURRICULUM DESCRIPTION 

1) The medical student was assigned to one day at a faculty-supervised abortion clinic, in which 4-6 
patients are counseled and examined in the morning, and 5-6 procedures are performed in the afternoon. [ 
The student was expected to follow 2 patients through the counseling process and procedure. 

2) An evaluation of the experience at the abortion clinic was filled out by the medical students at the end 11 
of their 6 week rotahon in obstetrics and gynecology. \ "^ l 

» i 



PROBLEMS ENCOUNTERED 

1) Two of the 68 medical students assigned to the clinic elected not to fully participate in the experience. 
One student did not attend without notifying the clinic, and the other medical student attended the 
AM counseling session only, after a conference with the course director in which she stated she had 
religious objectidris to observing the procedure. 



? 



RESULTS 

1 ) Fifty-five of the 66 students who experienced the rotation evaluated the experience (83.3% response 
rate). 

2) 50.9% of the students scored the experience as a "5" (excellent), 16.4% as a "4," 14.5% as a "3" t 
(average), and 1.8% as a "2." No student scored the experience as a "1" ( not worthwhile). 

3) Overall, the majority (98.2%) of medical students valued the educational experience of one day at the 
abortion clinic as part of the third year rotation in obstetrics and gynecology. j 



Adores submissions to: Elena Rios, M D , M.S.P H. Teteprione; (202) 690-5384. 

Office on Women's Health. OASH FAX: (202) 690-7 172 

200 lnaeoenden.;e Ave.. N W., Room 730-3 
Washington, C. 20201 

DEADLINE FOR SUBMISSION: Friday, August 4, 1995 



42 



CULTURAL COMPETENCE AND WOr,-.eN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Medical Student Gender and Personality Typ^ as Factors m Cl:xnical 
Abstract Title: Evaluations or. a Junior Ob-Gvn Ro tation 



Elmar P. Sakala T,tie: M . D . , M . P . H 



Presenter- 

Affiliation: Loma Linda University Telephone: <9Q9 824-4762 FAX: (90^ 8:^4-4167 

(Medical School/ftesidcncv Program) 

Department of Gyn-Ob, Room 3401 

Address: Loma Linda University Loma Linda, CA 92354 

City Zip Code 

Completing ibc Abstract Submission Form 

■ All tdxt should be typed with<n the p«f»fnevers o< the box shown. Fonts no tmaJJar than 10 po«nts £hov()d t>e used. 
• Organise tt\e te;tt of th« abstract as follows: (1) objectivti of tha cufucuJum; (2) curriculum descnption; 
(31 pfob(«ms crvrountered: and (AJ results 



MEDICAL STUDENT GENDER AND PERSONALITY TYPE AS FACTORS IN CLINICAL 
EVALUATIONS ON A JUNIOR OB-GYN ROTATION. Elmar P. Sakala. MD. MPH. Loma Linda 
School of Medicine, Loma Linda, CA 92350. 

OBJECTIVES: The purpose of this study was to explore if medical student cIini(X»I evaluations 
on a junior Ob-Gyn clinical rotation are associated with gender and/or personality type. 

DESCRIPTION: Myers-Briggs Type Indicator (MBTI) scores, obtained on adrniasion to 
medical school, were used to identify students as: either Extrovert (E) or Introvert (!); either 
Intuitive (N) or Sensing (S); either Feeling (F) or Thinking (T); as Judging (J) or Perceiving (P). 
Students were categorized into either one of the type types in each pairing regardless of the 
strength of the direction of their score within the pairing. The relationship of 4 student personality 
traits (E vs I; N vs S; F vs T; J vs P), and gender to 5 components of students grades (Clinical 
Evaluation. Oral Examination, National Board Shelf Exam, OSCE history-taking, OSCE patient- 
rapport skills) was assessed using Students' T-test or Mann-Whitney test as appropriate. 
Statistical significance was assumed if p<.05. 

RESULTS: MBTI scores were available on 144 out of 299 (48%) junior students from the 
classes of 1993-94. Significantly more females than males were of the F type (55% vs 27%) 
compared with T type (45% vs 73%; p=,002). Female E types received significantly better grades 
than female I, male E or male I in OSCE patient-rapport skills (p=.027), Oral Examination (p=.01). 
and Clinical Evaluation (p=.0O1). No differences in student grades were seen between N and S 
types^ while i= types tended to do better on OSCE history-taking than T types (p=0.63). Female P 
types received significantly better grades than female J, male P or male J in OSCE history-taking 
(p=.03l). Oral Examination (p=.024), and tended to better on the Shelf Exam (p=.067). 

CONCLUSION: Extrovert women achieve significantly higher grades in OSCE patient-rapport 
skills, Oral Examirwitions, and Clinical Evaluations. Perceiving women received better grades in 
OSCE history-taking. Oral Examination, and tended do better on the National Board Shelf Exam. 
MBTI scores in male students did not appear to have any demonstrable impact on grades 
assigned. 



Addfc^s soomissions to: 6i«na ftios, M.O . M S PM. Telephone: (202) 690-588* 

0«<ee an Women $ M<;#iih, QikSH FAX; (2021 690-71 72 

200 lrv3*oenden>:e Ave.. N.W.. Boo<t> 730-8 
Washington. O <: 202Ot 

DEADLINE POR SUBMISSION: FRIDAY. JUNE 30. 1995 



43 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAl EDUCATIO 

ABSTRACT SUSMlSSl 
Absiract Title: Doctor i ng : A Focus on Women's Health 



f-.j''> '> ' ■ 

ABSTRACT SUSMISSIQINJ FORM 



Pf«5«nt8r; Stuort J. Slavin, M.D. Title' Co-Chair, Doctoring Course 



Affiliation: UCLA School of Medicine Telephone: (310) 206t875 Q p^;^. ^10)825-639^ 

<M«dical School/fl«$id«ncy Progrirr) 

Address: Oept. of Pediatrics, UCLA School of Medicine, 10833 Le Conte Ave, Los Angeles, C/ 

C/ty Zip Code 90095-17: 

Completing the Abitract Submiaslon Form 

• AM t9xi should tJ« typto y/nhin thr perimeters 0' the Oox shown fo^rj no srnnu^r rhar ?o poin?? ihcuirt ije usea 
■ Organrji lh« text of the a6ltr«ct «} fcHowi; (1) «fc;ecovcs 0/ ma Curr'cgium; (2) curriculum aescr.ption. 
(3) pfqtX enii o<^courtered:.fncl.f4[ results. 



f 



■J-ui— ^JJ-^rr 




Objectives: Doctoring is a three-year, longitudinaL ttuiltidisciplinary course taught at the UCL \ School of 
Medicine. Its overarching goal is 10 help medical smdcnts develop the knowledge, skills, and atLtades needed to 
practice medicine in a humanistic manner, with a biopsychosocial persp)ective, in a cost-efTcctive and appropriate 
manner, with a commitment to life>-long learning, in cooperation witli other health care professionals, with an 
cmpltasis on prevention and an appreciation for the fundamentals of primary care. Women's her.lth issues serve as 
n major focus of Doctoring in all three years. The objectives in women's hcalih arc wide ranging and encompass 
many health problems that impact greatly/directly on women and that have been historically underreprescntcd in 
medical school ciirriaila 

Curriculum Description: Doctoring spans the first three years of medical school at UCLA and represents 
approximately 10% of total curricular time for all students. The course content includes many tuples (such as 
ethics, prevention and public health, domestic violence, and substance abuse) tliat traditionally have received 
inadequate ciirrtctilar attention. The majority of leaching in Doctoring is in small groups, using problem-based 
lenriting. Students participate in a series of educational modules in the first two years in which -patients, usually 
standardized patients, present with clinical problems that then sen'c as the focus and stimulus for learning. A 
majority of the patients are women, and the range of women's health issues addressed includes rcenage pregnancy, 
high risk sexual behavior and soxtially transmitted diseases, breast cancer, cardiac risk factors and preventive 
medicine counseling, allocation of scarce resources, and gender issues related to smoking cessation counseling. 
Third-year Docioring studcnis.foUow and matiagc a fictional panel of patients. For each casr there is an initial 
encounter and then a series of follow-up visits so tliat students have the opportunity to observe and treat health 
problems that evolve over the course of the year. Topics addressed include contraception, coronary artery disease 
in women, depression, menopause, and rape. 

Problems Encountered: One problem encountered thus far, is the resistance to Ihe course on t^c part of some 
students, who fail to recognize the importance of many of the subjects addressed in Doctoring. Male students and 
Students interested in nonprimary care fields were most likely to rate Doctoring unfavorably. 

Results: Overall, Doctoring has been favorably reviewed by most students. Students who rated .he course most 
highly were women and those interested in primaiy care careers. The final year of Doctoring is cur;enily being 
implemented and an extensive evaluation is underway. The impact of the course on students and faculty is being 
assessed using multiple measures including objective e.xanis, OSCE's. and surveys. 



* * '*! I l i i^^aa^BM.^i»^MPg ag=n«— ag— — »■ .1 .. . .— .— — I .-I -T — -j-nT-.-—^^.^^— »*>^-^^Tn r- 



XiMfrtjn «ubml«siont to: l\tnt flios, M.O . M.S p M. Toiep^one f;C2l 690-59Q4 

Of»tc« on Wom«nii Hotuh. OaSh FAX. (^(202) eSO-'WiT^ 

200 Ind«p«r>denc9 Avo , N.W . Room 730-8 ^•''— -.. ^ — 

Waartington. Q.C. 20201 

DEADLINE FOR SUBMISSION- naoA.!, JU1.T 21, 1995 



44 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Primary Care Women's Health Fellowship 



Abstract Title: 



Presenter- Kathleen M. Thomsen. M.D., M. P. H . Title: Assistant Professor of Cl inical Family Medir 

Affiliation: UMDNJ-RWJMS Telephone: (and ?-^s-7fi7n FAX: fans) 9A^-«r^ 

(Medical School/Residency Program) 
Department of Family Medicine 

Address: One Robert Wood Johnson Place New Brunswick, New Jer = pv nRQni-nmQ 

City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be useo. 

(3) problems encountered: and (4) results. ^=^=-— — -^======== 



The Women's Health Fellowship at UMDNJ-Robert Wood Johnson Medical School, Department of Family 
Medicine is the first Women's Health Fellowship in Family Medicine in the country. Objectives. To produce 
academic physicians capable of providing care to women, teaching others about issues in women's health care, 
and investigating the appropriateness and effectiveness of health care services and procedures provided to 
women in New Jersey and the rest of the nation. To equip future physicians with the knowledge, skills and 
attitudes needed to care for, teach and study the major health and illness problems affecting women, their 
families and communities throughout the various stages of the human hfe cycle. Curriculum Description. This 

jj is a flexible two year fellowship allowing physicians to get more extensive training and expertise in primary 

care Women's Health. The program allows the learner to identify their needs and find appropriate resources 
to meet those needs. Clinical appointments are held in both the Department of Obstetrics and Gynecology 
and the Department of Family Medicine. Clinical sites from these and many other departments in the medical 
school are used. Study towards a Masters in Public Health degree through the Graduate Program in Public 

i Health is required. Course work includes standard and elective public health courses, a unique core track of 

teaching, administrative and research skills and electives available through the various departments of the 
Graduate School of Rutgers University. Original research is also required. Community involvement in 
women's health support and consumers groups, networking with national leaders in women's health and 
' medical conimittee worTc in women's health issues is encouraged. Problems Encountered. No major problems 
have been encountered. We continually face the challenge of "Why women's health?" and therefore need to 
repeatedly reinforce the relevance of gender in health care experience and provision of services. Future 
funding may become a problem as medical education dollars are reduced. Results. The first fellow (1992- 
1994) has graduated and has joined the faculty of the Department of Family Medicine at UMDNJ-Robert 
Wood Johnson Medical School. She continues to bring women's health issues to the attention of the medical 
students, residents, fellows, faculty and t rhe larger community. The second fellow (1994-1996) is completing 
his second year in a research and teaching focused fellowship. One of his areas of concentration has been the 
development of curriculum for teaching primary care to the OB/GYN residents at the medical school. The 
third fellow (1995-1997) has just begun. 



^rldra<., submissions to: Elena Rios. M.D., M.S. PH. Telephone: (202) 690-5884 

Office on Women's Health. OASH FAX: (202) 690-7172 

200 Independence Ave., N.W.. Room 730-B 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30, 1995 

45 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

^,^,,, . J, PAINLESS and COMPETENT PELVIC EX.\MINATION 

in iMedical Education and Continuing Medical Education (CME) 
Pr se rer: ^y ljIj, ^ yvallis, MD, FACP Clinical Professor of Medicine 

Aftii;a:ion: ^>;kNc i'X U fv i \Jc !^^( T^ M^, telephone: (Ul) l<i- mH1S FAX: (^-^ ) 7i- /. H t? 5^ 

(Meaical School, Residency Prcqram/'^'<^y-^ 

Address: '^ "J 5 E\,T b ?l^^ Sli j"^ M^^ /u-> , N"/ ( OU 

City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown Fonts no smaller than 10 points should be used. 

■ Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 

(3) problems encountered; and '4i results. 



A painless and competent pehic exam is every woman's right, regardless of her life-phase, disability or previous 
trauma. Unfortunately, many women walk away from a pelvic exam (performed by a physician of any specialty), 
feeling abused, bruised, in pain or discomfort, treated like a piece of flesh, embarrassed, patemalized and 
infantilized. Women resent it. At the same time, the woman's inability' to cooperate in the exam results in an 
incompetent, diagnostically inadequate procedure. The Teaching Associate program is designed to address the 
gaps in competence, painlessness and sensitivity on the part of the student and physician. 

The Curriculum: In a hands-on workshop, the trained Teaching Associates demonstrate the exam on each other 
and , as subjects of the exam, provide feedback to the learners. At the conclusion of the workshop, 

♦ The learner has been helped to identify with the woman patient and be sensitive to her set of values, her fears, 

concepts, misconceptions and to her own sensitivities regarding the genital e.xam and to treat the patient 
as a whole person during the examination. 

♦ has acquired the understanding of the principles of a painless exam, specifically, the principle of 

downward pressure on the perineum, a\'oiding rough and sudden movements, the principles of the 
"abdominal hand pressor, vaginal hand sensor" technique of bimanual exam, the principles of "ovary 
is as sensitive as testes" and "rectal exam could be but should not be uncomfortable". 

♦ has acquired or improved his/her skills of a gentle, painless, competent, sensitive, communicative and 

educational five-part pelvic e.xamination, including the e.xam of external genitalia, cervical speculum 

placing,-ebtaining specimens for Pap test and other indicated tests, bimanual vagino-abdominal 

abdominal examination,bimanual rectovagino-abdominal examination with stool testing for occult blood, 
while communicating with the patient at each step and attending to her comfort. 

♦ has improved his/her skill in detection and prevention of disease - by collection of clinical data and 

interpretation of obtained facts 

♦ has improved his/her skill in insuring the patients' maintenance of health through patient education about her 

own body and about the actual examination procedure, instruction in self-e.xaminations ( e.g. breast and 
external genitalia); in encouraging and facilitating feedback and participation from the woman during 
the examination by asking her questions and soliciting her response and questions; and in sharing with 
the patient information derived from the e.xamination and collaboratively planning the futiu"e 
management. 

♦ has increased his/her understanding of the special problems in the pelvic e.xamination of an adolescent patient, 

elderly woman, disabled woman, a woman with a language barrier and a rape survivor. 



Addre*?"? submissions to: Elena Rios, M.D., M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health. GASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington. D.C. 20201 



DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 ^g 



I 

CULTURAL COMPrrSNCS AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 
I ABSTRACT SUBMISSION FORM 

jsiacr Title- ^'-'ocacry-based .^tedical School elective on Domestic viclence 

esemer: Carole Warshaw, .MP T;H,OD-Dixector, Hospital Cr^sxs Inter-.yent.lon Proje: 

iH.ltion: cook County Hospital Telephone; f31^ 43a 2390 FAX: (312)433.2391 



(Medical Scfwct/Pwidency Progr^til 

Jjj. 1835 W. Ftaxxiscn, Rm. 3427 Chicago, TL 60612 

City Zip Code 



^c Kiss: 



}n |ietfng tti« Abttrict Submission Fonn 

M Irxt jhould be typed vvitfwn tht pefiniet«r» of iff tax shown. Fonts no smatter xhun 10 points »houJd ha uttd. 
Or^praze the rtxt o/ th« abstract «t fallewt: (1) obfectivei of the cuniculun; 12) eurhoium dwcrfpiion; 

•mf fn«Qunftftd: 9od («» fnuftS. 



Anvoci 



:acy-basea Medical School elective on Domestic Violence: C. Warshaw, 
V. Coffey, B. SchultZ; L . Schilling, A. Gottlieb. Hospital Crisis 
l||tervention Project Chicago, IL. A ten week elective for first and second 
>Bar medical students was piloted by the Hospital Crisis Intervention 
Project, a collaborative domestic violence advocacy and training program 
c^ the Chicago Abused Women Coalition and the Cook County Bureau of Health 
^■rvices. The course was offered at the University of Chicago's Pritzker 
s"bool of Medicine. It sought to build an understanding among students of 
the social context in which woman abuse occurs and which shapes the values 
cjd attitudes of both physicians and patients. The course was designed to 
cBdress the difficulties that health care providers have in changing 
attitudes and behavior in ways that would allow them to fully integrate 
routine inquiry and intervention about domestic violence into clinical 
pBactice. Course instructors sought to create a safe environment for 
students to explore their own complex feelings about gender, abuse and 
power and welcomed the opportunity to create a more in depth learning 
tlperience on this important issue. Based in the expertise of both 
diivocacy and medicine, the course conveyed the complexities of domestic 
violence in way^ that a traditional medical school approach cannot, 
/jgivocates and foTmer battered women emotionally engaged students in the 
cBnamics of abuse and the issues women in abusive relationships face 
tnrough f i Im , v ideo and personal s tor ies . The medical implications of 
domestic violence and t he " inlieTvTewing and intervention skills necessary 
^m assist battered women were conveyed both didactically and e.xper i ent iai I y 
through Jjecture , rp^le j5 lavs^ and discussions. Several meetings of the class 
were devoted to site visiXa to a bat tered women's shelter, domestic 
^j^olence cpurtv and the Hospital Crisis Intervention Project. Students 
ippt journals of their changing perceptions over the 10 week period and 
were encouraged to see themselves as a part of a broad community response 

J domestic violence. Journals and evaluations of the course both showed 
significant change in attitude toward a more compassionate understanding 
battered women's experiences and a confidence in interviewing skills. 
A significant number of students reported increased extracurricular 
cMtivity around the issue of domestic violence. Additional interviews with 
ijudents are planned annually throughout their medical school training. 



w 



XH ... •-*-'- n. Telephone: (2021 Of0*lit4 




1 



200 Neommct Av... n.w!1IL 730-8 '^' 

Wuningien. DC. 20201 47 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION ' 

ABSTRACT SUSMiSSlGN FORM ■ 

Abstract Title: Doctorinz; An innovative curr ic ulum teaching medical scuaencs abouc domestic 

vioien 
Pr«3«nter: M-frhAPl WJLlkes. MP. MPH Till a". Assistant Professor o£ Medicine 

Aftiliation: UCLA School of Medicine Ttfephont: niQ 206> 3708 FAX: (310) 206.Q719 

(M«dic»l School/fl«*<d«f«v Pfoflr«rp) 

Addftss: UCLA Department of Medicine Los Angeles > CA 90095-1736 

City Zip Code 

Comp}«t(ng the Abttreet Submittlon form 

■ AM r«xt ihogid b« tvP«5 within the p»fim«(tri of the &oa shown. Fo'^ts no imiif«r than 10 pointi i.'iouW b« ui«d 
• Orgtn<2« th4 ttxt of th« sbftrtct ta follows: (1) Objectives of tha cu/rleuium; (2) curriculum dMchption; 
(2) prob(«iTu •ncouptsred: and (4i rt9glta. 



Objectives of Curriculum: Over ihc last decade, violence has been recogni/cd as a major public health problem in America. 
As such, the medical community constitutes a front-line for identification and intervention Unforiunatcly, practicing 
physicians, from family physicians to orthopedic surgeons, claim they rarely, if ever, encounter vjctims of domestic violence. 
Urifortunatcly, physicians and otJier health professionals arc ill prepared to offer their patients help in :lus area, largely as a 
result of the absence of violence education from undergraduate, graduate, and continuing medical education curricula. Far 
more important than teaching statistics and facts is for physicians to acquire the skills necessary to become comfortable 
discussing issues that delve into the darkest of personal secrets Victims are oRen willing, even eager, to talk but only if they 
trust that the physician is on their side. Our objectives arc to assure that students are familiar with -""^fmitions of domestic 
violence, barriers that e.xist to victims seeking help, cultural differences and their impact on domestic abuse, predisposing 
factors for abusers and victims, "red flag" indicators of abuse, skills in communication, legal issues, and interventions and 
treatments. Doctoring's overall goal is for students to develop attitudes that allow ihcm to look beyond the "presenting 
problem" to the person and the context of their medical concern. 

Curriculum Description: To break this cycle of ignorance and insensitiviiy UCLA's new Doctoring Curriculum (a case 
based, problem based curriculum) has developed an approach to learning about domestic violence that is longitudinally 
integrated through medical school. The teaching approach used in Doctoring incorporates many of the recommendations of 
recent consensus conferences, i.e.. teaching is interactive and experiential. We integrate problems of violence into all three 
years of the curriculum; topics arc taught in an interdiscipiinan manner that includes the perspective of victims. Concepts of 
adult learning theory arc practical and applied rather than theoretical. In small groups, faculty and siud'^nts work to first view 
a videotape of a couple and their doctor. Students discuss the subtle interaction and any problems. The gioup tltcn "invent" an 
interview format that would work to elicit sensitive issues surrounding domestic violence. Then, in front of the group, one 
student interviews a standardized patient (SP) who presents slating she "has a headache following a niotor vehicle accident." 
but whois actually a victim of domestic violence. Through this interaction students have an opponunuy to practice their 
communication skills and test their new approach to eliciting a history of domestic violence, Finally, this SP interaction serves 
to drive the problem based learning that occurs over the next three weeks Some students visit battered women's shelters or 
attend court hearings while others meet with prosecutors, emergency room social workers, police officers, legislators. Finally, 
the class has an informal discussion with a panel of battered women and abusers. 
Problems Encountered: Strong need for faculty development 

Results: Our domestic violence curriculum is currently under evaluation by the Centers for Disease Control and Prevention. 
Our students currently being compared to a "control" group of n^cdical students that receive only lectures on domestic violence 
In addition, we have shown that as a result of both faculty development and teaching in Doctoring our faculty have 
demonstrated impressive gains in their knowledge around issues of domestic violence. In addition, ihey report bringing back 
to their clinics, private practices and clinical teaching a new approach to interviewing women and screening for issues of 
domestic violence. 



^ 



Xiuirp^'. submit*, oni to: 6ler»a Rioj. M.O , M.S PH. Telephone. (202; 6»0-588< 

OffiC* on Womcn'i M««ith. QASH FAX; (202) t90-fMl 

2C0 !ridtp«ftdtrtc« Avt . N.W . Room 730-8 
Wa3^.^Qton. OC 20201 

DEADLINE FOR SUBMISSION- F&XDAT, JtTLT 21, 1995 



48 



I 

CULTURAL COMPETENCt AND WOMEN'S HEALTH CURWCULA \H MEDICAL feUUVAi .wt^ 
I ABSTRACT SUBMISSION FORM 

;u It Title: -r% \^-:lj£L "R.^-u^ ^-t^^— Og^H-ru. 'SccLfe«-M Ai-^n -rv^ X>A^-.^L^.a^ 
8«nt«f : yj v^ ^,^ ^,v^ u; . M cv>Af^ KA. O _ r.tie; M^-Pp ,A:^<nI^Y^ pfip<=g^:&0^ 

« |on! 1^ /y p T^c<jr^ JLfeoc^ ^OUJIcitpHonet {M6.Jn-.SDQO FAX: LRJ^SO- 5-<-/S^ 
(Mi^iMl S<:hooi/iK«tidtf)cy ProgrMn) 

0V-V6. >u£OiOVU'aje*-vit<^ O^uc^, City Zip Code 

V^tft^ tht Abftraot Submiuion Hm 'I^e^^c^ ot5>l6HH 

i t Is »hevl4 bt wp«^ withtn the oenmetcr» of the box sh&^m. Fonts no smafi«r than 10 points shegid bt us#d. 
'SlAk* tht t«n of The tb$\f^- » foBowe: (1) ^ejectives of the eurricutum; (2) eurrieutgm tfeecrtption; 

) 0roU«m» encowntertttf; and (4) resuttt. 






roaa 



Abstract 

The broad objective;* of the curriculum were to heip fourth year medical students 
identify and understand essential social and cultural issues related to medical decision 
making; to become effective adult learners; and to experience the benefits of active 
learning in a cooperative group process. The Home Birth Case challenged students to 
learn more about *he morbidity and mortality related to childbirth, the history of 
maternity care, international and cultural variations in care, settings and attendants for 
childbirth, the cost of care, patient autonomy, legal responsibilities, and similar issues. 

During a scheduled appointment, a young couple explains to their physician that they 
plan to have their baby at home. A midwife will attend. Will you be the baclt up should 
some problem arise? The case is presented to a small group with a facilitator. Students 
will identify issues, assign home work to each other, research the topic, speak with 
designated experts and report their findings to classmates. All small groups attend a 
forum with a home birth attendant, medical anthropologist, obstetrician, and Certified 
Nurse Midwife. A network news report on home birth triggers the forum discusswn. 
Pad Two otthe Uome Birth. Case is presented later. This case is part of a 7 week 
problem baseJ course with 11 cases. It has been taught for 10 years at Dartmouth 
Medk^l School. 

Problems: 1 . The development of effective problem based learning cases required 
significant effort. 2. Small group sessions require labor Intensive facilitator time. 
3. Pertinent clinical problems, cultural influences, and the rote of the clinician all 
change over time. The course requires regular reviston. 

Results: Faculty and student evaluations of the course have been 80-90% favorable. 
The students reported that the Home Birth Case gave them a broader understanding of 
ethical, economic, cultural, and public health aspects of maternity care. 



L= 



Auttmosions to: Qtrta Riot. M.O., M.S.^H. T«i«phen*: (102) e9Q>6t«« 

Oftteo on Vivrm't HeoHh. OASH FAX: (lOi) 890-7172 

200 tndMkMOtAC* Av«.. N.W . I^oom 7)04 

WMhiA^en. ox. 20201 

OeAOUN£ fOA SUBMISSION: FRIDAY. ;HMC'3ert9t5 



49 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATIO; 

ABSTRACT SUBMISSION FORM 
Abstracr Title: '^^^ Culture and Society Seminar for Undergraduace Medical Students 



^^. Liza Cariaga-Lo, Ed.D, "'.-'p- Instructor in Medical Education 



°''esenter: ^ , ^ . . . . g. 

Bowman Gray School of Medicine of 

Atfiliation: Wake Forest University Telepnone: ■; 910 716- 5 686 FAX: 910' 716-5607 

'Meaicai Schooi/Hesicencv Prcgrami 
Office of Educational Research, Bowman Gray School of Medicine of Wake Forest University 

Medical Center Blvd., '.v'inston-Salem, NC 27157 
Adaress: . . 

City Zip Coae 

Completing the Abstract Submission Form 

■ All text snsuld be tvces withm xrt urtmete'r of the box snowo. Fonts no smaller man 10 points snould be usea 

■ Organize tne text of the abstract as follows: (1) ooiectives of the curncjium; (2) curriculum descnonon; 
(31 DroOlems encountered: and (4.; cesults. 



1 He Culture ana Society Seminar for Undergraduate Medical Students 

Liza Cariaga-Lo, Ed.D. 
Bowman Gray School of Medicine of Wake Forest University 

Objectives of the curriculum: 

The purpose of this curriculum is to educate first and second year medical students about the cultural 
and environmental factors affecting the health status of diverse population groups so that: 

1 ) They will learn generally about the status of different population groups in this country, particularly 
those who are underserved with respect to health care. 

2) They will be informed about the health care needs of diverse population groups. 

3) Medical students will be provided with practical, hands-on knowledge on how to help individuals 
from culturally diverse populations have better health care access and utilization. 

Curriculum description: 

The curriculum is designed as a year-long elective seminar for first and second year medical students. 
Through hour and a half sessions every two weeks (approximately 16 sessions) , students are given 
j-didacticlectuifi or presen.tation in the first half-hour to introduce the health care needs of a specific 
population group. Faculty and invited guest speakers who are knowledgeable about the health care 
issues related to that week's topic will provide the lectures. A problem-based learning (PBL) case 
correlated to the lecture is then used to facilitate discussion in small group tutorials regarding how one 
might approach the most culturally-sensitive and appropriate health care management of the individual 
in the PBL case. Each PBL case is designed to be discussed in two sessions. There are currently 8 PBL 
cases in development, each one addressing health care issues related to one population group 
Students will also be required to meet with an individual from any of the population groups discussed 
in the course and write a report about a health care issue of concern to this individual. An extensive 
reading list which includes research articles, oral histories, literature excerpts and demographic reports 
of relevance is provided to students. 

Problems encountered and results: 

The curriculum is in development and will be implemented as a pilot proiect m Fall 1995 with a croup 
of no more than 10 students. 



V <,(r(»<f. suomissions to; Eiena nios. M.O.. M.S ? H. Teleonone; (202! 690-588«i 

Office on .vomen «; --aith. OASH FAX; (202! 590-7172 

200 inceoenaence Ave.. N.W.. Room 730-5 
Wasrinctcr.. O.C. 12201 

DEADLINE FOR SUBMISSION: FRIDAI. JTJLT 21. 1995 



50 



I 



CONFLUENCE OF CULTURES IN MEDICAL EDUCATION: 
LISTENING TO PATIENTS AND OURSELVES 



I ABSTRACT SUBMISSION FORM 

rf^bstract Title: Confluence of Cultures in Medical Education: Listening to Patients and Ourselves 

Presenter: Patricia N. Carver, Ph.D. . Title: Clinical Associate Professor of Family Medicine 

Robert C. Like, M.D.. M.S. Associate Professor of Familv Medicine 

Affiliation: UMDNJ-Robert Wood Johnson Medical School Telephone: (908) 235-7662 Fax: (908) 246-8084 
(Medical School/Residency Program) 



t 



ddress: 1 Robert Wood Johnson Place New Brunswick. N.J. 08903 

City Zip Code 

ompleting the Abstract Submission Form 

All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 
Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. 



Overview ; The overall goal of this educational project, funded by the Robert Wood Johnson Foundation, is to enhance 
ethnosensitivity in the delivery of care through the use of videos and other didactic material. 

Ohjectives of the Ciiiricuiiini : After participation in this project, individuals will be able to: (1) discuss the myth of 
homogeneity within ethnic groups (2) relate concepts of culture and ethnicity to family health culture; (3) discuss 
ethnic variations in value orientations, world views, family systems structure and functioning; (4) describe the health 
and illness beliefs and practices of selected individuals/families from different ethnic backgrounds; (5) perform a socio- 
cultural assessment of families and elicit explanatory models of illness; and (6) describe their own personal attitudes, 
beliefs, values, and reactions to diversity. 

Cnrriciiliini ; The curriculum consists of presenting the above didactic material in lectures, seminars, and workshops. 
A unique and critical component of the curriculum has been the presentation of videotapes made specifically for this 
project. We have produced a total of 10 tapes of families: 4 families with developmentally disabled children, 1 family 
who lost a mother to cancer, and 5 cancer patients. Each person comes from a different ethnic background. Each 
discusses her/his views of health, illness, religion, death, family support, the American medical culture and experiences 
with the health care system. In addition, we have used exercises and simulation games to provide an experience in 
ethnic diversity. Participants e.xperience difficulties and frustrations involved in adapting to different cultures. 

Problems ; Several challenges needed to be addressed concerning both the topic and the production process. Although 
recognized by many as-important issues, the impact of culture on medical care and the importance of enhancing 
ethnosensitivity of caregivers have been met with some resistance by students and faculty., Some have suggested that 
the topic is self-evident, while others have questioned the relevance of what they consider "soft" material. Production 
problems included difficulties in scheduling interviews, technical support, and the amount of time needed for editing. 
Additional production challenges included language and communication problems, e.g. accents. This problem is 
surmounted by using slides of the video text. 

Results ; Our success has been measured partly by: the increasing number of invitations to present, the nature, variety 
and increasing size of our audiences, and the ver\' positive responses to national and international presentations. Since 
this project began in 1992 we have presented to more than 250 medical and public health students and over 1500 
faculty and health care providers. We have begun to formally evaluate the impact of the curriculum on awareness, 
knowledge, attitudes, beliefs, and the impact of the videos on the extent to which they emphasize or illustrate: 
concepts, diversity within ethnic groups, family health beliefs and values, explanatory models, and the impact of 
ethnicity on care. Preliminary results from both written and oral evaluations indicate moderate to high impact. 



I 
I 
I 



ddress submissions to: Elena Rios, M.D.. M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health, OASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION; FRIDAY, JULY 21, 1995 

51 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM ' 

Cultural Competence Curriculusi for Health Care Providers; Hispanic Module 



Abstracr Title: 

Director, Division of Coimnunity Health 
Presenter- ^^^^^^ Cora-Bramble, KD,FAAP i-jtjg. Ihe George Washington University Medical ( 

"xhe George Washington University School '5!^itici:^i'£"8iilk^^§5itS!ii'^" '°^" '^" 
Affiliation: Latin American Youth Cente_r Teiephone; (202 917^2991 FAX; fini) ^Qrwini? nr 

(Medical School/Residency Program) (202) 994-8531 

The George Washington University Medical Center, Dept. of Health Care Sciences 
... 2150 Pennsylvania Av6., N.W., Washington, D.C. 20037 

City Zip Code 

Cortipjeting the Abstract Submission Form 

■ All rext shoulo be typed wit^^m th« perimeters o^ the box shown. Fonts no smaller than 10 points should be used- 

■ Organize the text of the abstract as follows.- (1) objectives of the curriculum; 12) curncuium description; 
(3) problems encountered; and (4) results. 



OBJTCTIVB: To enhance the effectiveness of health care delivery to 
ethnic and racial minority populations by training physicians, 
medical students and other health care providers to deliver 
culturally competent health care. Year I objectivet To develop and 
implement the Hispanic module of the cultural competence curriculum 
for health care providers. 

CURRICTTLUM DESCRIPTION: The Project "Puente de Salud/Bridging Gaps 
in Health Care" was developed through a grant from the Office of 
Minority Health to the Latin American Youth Center. The primary 
care departments of teaching hospitals in the District of Columbia 
were surveyed to assess: (1) the status and extent of cultural 
sensitivity training and, (2) their interest in offering Hispanic 
cencered curricula to their medical staff and students. After an 
extensive review of the medical literature, a model curriculum was 
developed by the project director, who is a bicultural/bilingual 
physi':ian. The introductory chapters addressed the definitions of 
cultural competence, a description of the Hispanic population, 
issues related to terminology and cultural heterogeneity. 
Subsequently", Hispanic health issues are covered in detail in 
relationship to mortality, morbidity and diseases that are 
prevalent among Hispanics. A unique feature of the curriculum 
includes the use of "clinical applications", or a translation of 
scientific data into practical tips for health care providers. The 
final chapters cover the critical issues of access to care and 
culture specific behavior. 

PROULBMS ENCOUNTERED: Initially, the response rate from the survey 
was less than optimal. Follow-up calls, visits, and multiple 
mailings were necessary to increase the number of surveys returned. 
RESUI-TS: During the ten months of the project, the curriculum and 
related data has been utilized to train approximately ninety 
medical students, physicians, physician assistants and other 
providers at The George Washington University Medical Center, 
Howard University Hospital and at a national conference of the 
National Health Service Corps. 



'Vd.lfpts submissions to: Elena flios, M.O., M.S.PH. Telephone; (202) 890-5884 

Office on Women's Health, GASH FAX: (202)690-7172 

200 Independence Ave.. N.W., Room 730-B 
Washington, D.C. 2020^ 

DEADLINE FOR SUBMISSION: FRIDAY, JULY 21. IW5 52 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: INTERCULTURAL FAMILY MEDICINE CURRICULUM 



Presenter: K. A- Culhane-Pera, MP, MA jjtip; Director of Cross-Cultural FcTinily Medicine 

Si. Paul Kanisey Faniilv Medicine 
Affiliation: [ Telephone: ( 612-221-3540 FAX: ^FAX 612-222-1816 

A^Hro.c 640 Jackson St., St. Paul, MN 55101 USA 

Address: ^____„_ 



City Zip Code 

Completing th9 Abstract Submission Form 

■ All Mxt should be iY\**ni within the penmeters of rhi 6ok shown, Fonts no emiller than 10 points thould b0 utod. 

■ Organlif th« tixt of the abstract ai follows: (1) ot^actlvfi of the curriculum; |2) curriculum description; 
<3i preblems encountarsd; and (4) rekulta. 



Objectives: 

The goal of our tnulticiiJlural rurrirulum at St. I'uul Ramsoy Mcdicul Center Family and Commur^ily 
Mcdirino n'sidi-ncy )TOf/am is to wiMSt residenlsjn the practice of hiyh quulity, curing, respectful, and 
hcaliny rclalionshiiv; with pcDpk- of all cultural backgrounds. Tho Ic^tirixiny objecUves arc arranged jiUo 5 
levels of cultural coinpelunce, following bci-uicll's Developmental Model of Intcrcultnrnl Sensitivity. While 
our roquircmc'iil is to have ovoryone achieve I.evol 3, niuny residents aini for Levels 4 and 5. Content is not 
focused solely upon ethnicity, but indudr many factors which influence people's cultural orientations: age, 
gender, socio-cconouaic cJas.s, formal education level, biomedical Irniixing, reli^<ui, sexual orientation, etc. 

Description: 

We have yearly day lojig seminars, two of wliicli arc? repealed for the incomu^g residents. The first 
workshop deals with the basics c>f ciUlural diversity in medicine; videotapes, small ^oup discussions, and 
exercises are used to explore how culture influences individuals, both providers and patients. The second 
workshc^p drals with uiler-oullural c'ommuniCiilic>n skill.s; drawing upon patient-cenlered ron\unu\icalion 
phJlosopliy and melhod.s the re.sidents practice the A.sk-LEARN model with three different simulated 
patients who repr-.'^riMU diff«-.'X'nt ciillural backgrounds. The third CARE in WuUer 19^5-1996 will dcnl wilh 
institutional tacism. Other methodologies o<:curmj», lliroughoul the year include grand rounds, noon 
sessions, case confen?ju e.s, vidootapmg, 1:] proceplifig, and ct)mm\u'uly medicine projects. The; program 
evaluation is multifold: residents ovaluule themselves on knowledge, .skills, and ulljludefi of level 3; faculty 
CVflluatcrcsicUails' general. attitudes and skills; and both faculty and residents complete an ellinosensitivily 
queslioimair*? at yearly intervals. In addition, we seek participants' feedback and (^valuation of the 
c-urriculum after workshc>ps ajid pre.sentutions, and ii\ group discussions. 

Probletns enrountcretl: Chalh'nges to the curriculam have included resident and faculty hexitancies to 
openly discuss sexism, racism, homophobia, and classiKm; desires for clinically applicable iivfoni\ation 
which is often rciUiClionislir while (.riticizing generalities as stereotypes; miiiiuii2:ation of the importance of 
culture while stressii^j^ the universcilily of hiomedit ine and doctor communication; and ellinocentrist 
orientulion that l^iomedii ine is superior to other healing forms. In addition, some residents ar<! tluealened 
by faculty's attempts to leach ..lliiudes which they feel Ihcy already have. 

Results: Results of the curriculum arc mixetl. The residents' self-evaluations and faculty evaluations iiidicale 
improving knowledge and skills. The queslionnuiie bus been unable to nieasure implx^ved etluiorclativism. 
Presently vve an* making modifications to address the resistances described above. 



AOrtra^j $ubmi6»loni to: Elena Rioa. M,0.. M.S. P.M. T«(»phon«: (202» 690-5884 

Offio* ofi WemQrtc Health. OABU FAX, (202» 090-7172 

200 ln<lap«nd«nce Avt., N W., Room 730-8 
Washingiftn, D.C ?ft7ni 

DEADLINE FOR SUBMISSION: PRIDAY, JUNE 30. 1905 

I 

53 



1 



CULTURAL COMPETENCE AMD WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
ADsujci Title: R2ce , C^ilture and Ethnicity: Addressing Alcohol and Otner Drue Problems 
Prosemer- Catherine Dwbe', Ed.D. ^..Assistant Professor (research) 

Affil.ation: Brown ^ Univ ersity Telephone: [^ 863-2951 p^^. y 1^863-3510 

Co-Authors; R. bo-dman, A . Konrcfe , C. Lewis, R. Rosen 
Addross: B^own University, Sox G-5H Ale Ctr, Providence, RI 02912 



City Zip Code 

Completing the Abstract Submission Form 

9 All ten should he lypod withm iMe Dorimotsrs of tho box shown. Fonts no smaller than 10 polnij should bo us«d. 
• Ofy.inize ihe text of the absuact as follow?: m objeciives of ih« curriculum; (2) curriculum doscfiption; 
(3) P'Obloms enco'/nterad; and lA] rcsuMs. 



Race, Culture and Ethnicity: Addressing Alcohol and Other Drug Problems This curriculum is 
designed to erJiaiice panicipants' understanding of how their own ethnic background affects patient care; 
to broaden their perspectives on substance use in cultures different from their own; and to provide 
participants with tools to better assess and diagnose substance abuse among diverse patient populations. 

1) Objectives: At the end of this curriculum, students will be able to: a) describe patients' various 
perspectives and expectations regarding health care services and how cultural perspectives affect 
behaviors, values and beliefs; b) descnbe the universality of culture while considering one's own ethnic 
and cultural background and how it affects one's own perspective, values and beliefs; c) describe cultural 
clashes which may occur in the medical setting; d) describe the meanings and acceptability of alcohol or 
other drug use, intoxication, and addiction or dependence in different cultures; e) describe coping 
strategies, risk factors and historical factors which may influence substance use behaviors within a 
cultural group; f) describe communication concepts imponant in cross-cultural patient interactions; g) 
describe limitations of existing diagnostic criteria and screening techniques when used in culturally 
diverse populations; h) given a role play patient structured to illustrate some important characteristics of 
culturally diverse people, demonstrate the use of appropriate communication, substance abuse screening 
and assessment skills. 

2) Curriculmn Description: The format of this curriculum differs from others in that we intentionally 
do not supply a L'st of cultural "facts" for the participants to memorize, but instead focus on concepts and 
issues that are broadly applic^le across cultures. We have found the former approach to be 
unproductive because it fosters stereotyping. Our objective is to provide participants with an informed 
base from which to continually expand their contextual knowledge and understanding of substance use 
among their own patients, and while providing training in skills which are sensitive to diversity. The 
curriculum includes a teaching video and instructor's guide with instructional outlines, supporting visuals, 
handouts and instructions. Modules include: a) Introduction and Overview; b) Cultural Self-Awareness; 
c) Cross-Cultural View of Health Care and Alcohol and Other Drug Use; d) Cross-Cultural Simulation 
Exercise; c) Risk Factors, Stress and Coping; f) Skills for the Health Care Provider: Screening and 
Intervention; and g) Skills Practice and Application. 

3) Problems Encountered: Many learners will specifically request "cultural facts" and laundry lists of 
cultural characteristics of different ethnic and cultural groups. We have chosen not to take this approach, 
and this fosters some dissatisfaction. 

4) Results: This curriculum has been successfully pilot tested and implemented at Brown University for 
3 years. Student ratings are among the highest for this type of seminar. 119 copies of the curriculum 
have been disseminated nationally. 



t<it:i''-'- ■ .submiss'Oi"*^ to: Elena Rioi. M.D., M.S. P.M. Telephone: (202) 690-S88'J 

Office on Women's Health, CASH FAX: (202)690-7172 
200 indcpend«nce Ave.. N.W., Room 730«B 

Wesningion. DC ;>.0201 J^-% ^ ''^'^^' 

DEADLINE FOR SUBMISSION: FRIDAY, ^ h tf 6.-1995 

54 



I 

! 
I 



. — V . ^r^^^ ^UMPETENCe ANU WOMEN'S" HEALTH CURRICULA IN MfcDiCAL EDUCATION 

ABSTRACT 4JU0MISSION FORM 
Cultural Diversity Conferences for Psychiatry Residents 



Ti , Outpatient Chief Resident. Peychia; 
'H'©' ^ — ■ ■' ■■■ 



Absiriio' Title; 

_ Jajnal Fawaz , M.D. 
^feseoiffr: — ...^_____ 

,V«,i„„on. Ill:t i:t:i :i TZH:U To,.pHon.: ,410 326-6OI8 . fax: tiO_iZB,6391 _ 

701 West Pratt Street, Second Floor. Baltimore. Maryland 21201 

Addrass: ^_^ • — — 

City Zip Cooe 

Completing t>)9 Abstroot 5ubrni«9ion Form 

• All uxt »M&uid ho tyMwO wiihln ll»o poiifucton cl the box ihown. ror»« ftO jm*"*- t'i#«^ ^0 pO«ni» siiwul^i Iw u»0d- 

• Oro«fti«e tho u-jrt o* tt>« abstract bi fQiiow*; (1) oojeciivet OT lh9 CUfnculum; (2J curricu»wm OMWiptienj 
(.11 p'oblcmi •ncou»^\«r»d. «nd M) r«tMlt£. 

CULTUflAL DIVERSITY CONFERENCES FOR 
PSYCHIATRY RESIDENTS 

Chairperson: Jamai Fawaz, M.D. 
Partlc!pan:z: Michael A. Torres. M.D. 

EDUCATIONAL OBJECTIVES: 

At the conclusion of this prtsentation, the p«nicipsat sbould be 
able to understand recent trends in Incrcaaing cuitural/etboic diversity 
in residency programs: potential problems relaied to the inaeased 
diversify; and the benefit of cultural diversity conferences designed 
to address the potential problems. 

SUMMARY: 

The A?A resident census dau for the last five yean indicate that 
the perrec-age of minorities and IMG's has Increased whflc the 
percentage of white residents and AMC's has decreased. These 
changes have resulted in an increased degree of cultursl/ethoic diver- 
sity in inf^iy training programs, and it is likely that these programs 
wrestle with the challenges that this diversity prescnts- 

We have planned and implemented a one*day culniral diversity 
conference in cur residency program designed to foster an apprecia- 
tion among residents for various backgrounds and to di^i myths 
and stereotypes that hinder cohesiveness. The coofereoce was led by 
five faci'nators representing African- American, Jamaican-American. 
Brazilian, and European-American cultures. A large group forum 
- wa«-«»ed to iriroduce concepts related to cuituml sensitivity. Resi- 
dents wTc -Jivided into five culnuaily heterogeneous small groups 
in which they participated in exercises designed to meet the above 
noted objeaivcs. Thj^^effectivencss of the program was evaluated 
_by having residcms complete a brief survey before and after the . 
coiifcrencc. 

We anticipate that out conference will serve as a useful model 
and that discussions of our design will help improve it and help 
representatives of other programs design their own. 

REFERENCES: 

1. The 1993-94 APA Census of Residenu. 

2. Lun CK. iCorenman SG: Cultural sensitivity training In US medi- 
cal schools. Academic Mcdicint 69:239-241. 1994. 



A/M'u** awbiw^d 



Cloo« «IO». M O., M.S.^ H. 

OHiba on Womt,n'v Hr«Uli. 0A5M 

200 Indcpcndflnca Ave. N.W.. fXoofn 730*0 

Wo^hinotOM. O.C 20201 



Tcltpnonc- 

FAX; 



(2Q2) e»o«oe9'» 
(202IM0'717: 



DEADLINE fOrt auBMIiSION: FRIDAY. JUNE 30, 1995 



55 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: PHYSICIAN TRAINING PROGRAM TO ENHANCE ADHERENCE AMON G UNDERSERVED 

MINORITY WOMEN ~ ' - 

Presenter: mona pniifln m n m p h Title: ASSISTANT PROFESSOR - 

Affiliation: UNIVERSITY OF ALABAMA AT r^ipphon^: PO^ 934-2125 FAX: (203 934-7959 

(Med.cal School/Restdency Program) 

1717 Utii Avenue South MT 729 
Address: Preventive Medicine Birmingham, AL 35205-4785 

University of Alabama at Birmingham "q^ Zio Code 

Completing the Abstract Submission Form 

« AM text should be r- ped within the penmet-rs of the box shown. Fonts no smaller than 10 points should be used 
■ Organize the text ot ihs abstract as follows: (1) objeciives of the curricylum; (2) curriculum description; 
(3) problems encountered; and (4) results. 

11 



ABSTRACT: 

Background : Many efforts have been made during the last decade to improve public 
knowledge about hypertension and to improve hypertension control. Despite these 
efforts the rates of uncontrolled hypertension remain high for older individuals and are 
higher for black women and lower socioeconomic groups. Among the factors which may 
affect hypertension control in these population groups are cultural, gender and age- 
related considerations which in some clinic settings may vary between young health-care 
providers and their minority women patients. 

(1) Objective : The main objective of this proposed study is to evaluate the efficacy of a 
physician training program designed to enhance adherence with antihypertensive 
pharmacological measures in a low-income minority women by devoting attention to 
methods to improve physicians' skills in gaining patients adherence in settings that 
provide services to predominantly minority and low-income populations. 

(2) Curriculum Description : The program to be evaluated in the proposed study is a 
strategy to both educate and enhance resident physicians' behavior skills to improve 
patients adherence with antihypertensive medication among older African American 
women antf incHjdes: 

1) a culturally age-sensitive educational component designed specifically to assist 
physicians to address the physical and educational needs among underserved minority 
and low-income women who may be at high risk due to uncontrolled hypertension and 

2) a behaviora! component designed to assist physicians in promoting health adherence 
behavior and develop behavior skills using physician-patient interaction techniques. 

(3) Results: The present program will demonstrate that culturally-sensitive educational 
and behavioral training directed at health professionals can improve medication 
adherence among medically disadvantaged hypertensive women. This program, if proven 
efficacious, is capable of being implemented for other health conditions. This may 
subsequently result In the Improvement of the effectiveness of primary care services 
especially to minority women. 



^»ii1re?< submissions to: Plena Rios. M.D.. M.S P.H. Telephone; (202) 690-5884 

Office on Women's Health, OaSH FAX; (202) 690-7172 

200 Irvdependence Ave.. N.W.. Room 730-B 
Washington, O.C. 20201 

DEADLINE FOR SUBMISSION: FtEDAI. JULY 21. 1995 

TOTft 56 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: Ethnicity and Medicine: Teaching Cultural Competency 

Presenter: Ronald D. Garcia, Ph.D. Title: Program Director, Center of Excellence 

Affiliation: Stanford School of Medicine Telepfione: (415) 725-0403 FAX: (415) 725-5538 



(Medical School/Residency Program) 

Address: 851 Welch Road, Room 115 Palo Alto, CA 94305-5537 

City Zip Code 

Completing the Abstract Submission Form 

• All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

• Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. 



Ethnicity and Medicine: Teaching Cultural Competency: Ronald D. Garcia, Monica Carrillo, 
ft^ernando S. Mendoza; Center of Excellence, School of Medicine, Stanford University, Palo Alto, California 

Objective of Curriculum 

pL. To increase av^areness of the role of culture in patient-clinician encounters. 

2. To improve the clinician's ability to access information on their patients' cultural traditions, beliefs, 
^anguage, and expectations, especially in regards to the appropriateness of clinical interventions. 
■3. To teach how to integrate cultural information in patient-clinician interactioris. 

This one-quarter didactic course was offered as a lecture only, or lecture and small group discussion 

tourse. It was designed to examine the roles of ethnicity and culture in caring for patients. In addition, 
tudents were encouraged to examine their own cultural background and its contribution to the clinical 

encoimter. The primary teaching modalities included lectures, readings, and small group discussions. The 
Igconceptual framework for the course involved five major dimensions: (1) socioeconomic class; (2) 
jpthnicity and race as social factors; (3) ethnicity and race as biologic factors; (4) immigration and 

acculturation; and (5) health prevention and perception. These major dimensions were presented through 
^ series of eight lectures: The Impact of Ethnicity and Socioeconomic Status on Cardiovascular Health; 
feridging the Language Gaps: Interpreters and Other Tools; Childbirth in the Eyes of Indigenous Americans: 
"A Historical Perspective; Seven Directions Toward Healing: Spirituality as the Foundation for Addiction 

RecoveryrAlcohol Abuse/ Alcoholism: Culturally Competent Care for African Americans; Ethnic 
^Considerations in Transplant Medicine; Caring for Migrant Farm Workers; and The Cross-Cultural 
^Dimensions of Clinical Competence. 

The curricular problems encountered were that the breadth of each dimension was difficult to cover in 
Hgthe allotted time. The lecture format was good for providing information, but did not allow for students to 
■personally experience these issues which we believe would best reiriforce these concepts. Since most of the 

students were in their preclinical years, we emphasized factors that relate to physician-patient interactions 
gather than biomedical issues. More specific clinical examples would probably be better for clinical medical 
■students. 
• Assessing the success of this course was accomplished by comparing the number of participating 

students and their course evaluations of this course to other medical school elective courses. A total of 57 
Anedical and undergraduate students completed the course. This compares with an average of 25 for most 
Jelective medical school courses. On a scale of 1 to 5, the course received a 4.5. The school administration 

believes that this course has been successful and has made it part of the official curriculum. 



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Address submissions to: Elena Rios, M.D., M.S.P.H. Telephone: (202) 690-5884 

ONice on Women's Health OASH FAX: (202)690-7172 

200 Independence Ave., N.W.. Room 730-B 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JULY 21. 1995 

57 



ABSTRACT SUBMISSION FORM 

Abstract T'tle- ^^^''^'-^^^1 Competence in a Pediatric Clinic in a Managed Care Environment 

-. ^ . — . : . _ . _ 

Presenter: Deborah Gould, MP Title: Pediatrician . 



Aff ifiaiJon: Kaiser Permanente • Telephone: ^IQ 987--3016 FAX: eiOf 873>5142 

(M«d«ca( Schooi/BesUiencY PfogramJ 

Address: Physician Ed. & Dev., 1800 Harrison» 21st Fl., Oakland, CA 94612 



City Zip Code 

Completing the Abstract Submission Form 

« Ail text should b« typed %vtttvA tne pedmeten of the box ahown. Fonts no smaller than 10 pokAts'choufd be used. 
« Ocganlxa tha tsxc ol Che abstract «• fottows: 01 obiactivas of tha curriculum: (21 cuniculum descfiptiort: 

(31 fy-ot)(«ms ancoomcred; and (-<l racuftc. '* • . 



1. Objectives of. the curriculum- ; 

• Identification of probl^ associated with large proportion of physicians practicitig with an 
education not geared toward understanding diversity or practicing in a managed care 
environment . 

• • Outlining goal for intervention * . • . 

2. Curriculum description ,- 

• Referencing #1 above, decide how to re-educate practicing staff in a managed care; 
environment and incorporate leamings into new practice models 

3. Problems encountered 

• Difficulties in providing education 

- Cost . ■ " • . 

- Not understanding ■ - • 

- Resistance 

4. Bjesults '^ 

• Measurable results that can serve as means to demonstrate change: . " 

- Physician satisfaction * . ' . 

- Product development . ' • - ' 

- Market analysis (inci-e'ase- share, patierit satisfaction, community interface) - \ 



V<<(«*^«<4mi«ctoncca: e«<uBioi«MA;,f4.&PJH.= T^Mmm: . (202) €90^684 

...Of(iodoaWomMr<Ha«tOh.OASH FAX:. • WmtaXhlXtZ 

• • - 200 IndepandaAoe Av«^ MAVw Room 720« . . 
• WoaNf^tocy Q^ 30201 

1 • . ' C£AOUNe FOR SUBMI$StON: '^Ba]U]^**Jxnaf 21.-i995 * 



58 



r 

CULTURAL COMPETENCE AND WOMEN i* HEALTH CURRICULA IN MEDICAL EDUCATION 



I 



ABSTRACT SUBMISSION FORM 



-'ilitract Title: i -ACHING CROSS -CULTURAL MEDICINE 



I 



p: ^ ^ . Marvin L. Hage, MD jitlg. Clinical Associate Professor, Dept . OE/G" 

.|.l..„nn. ^"^^ Unlversxty Mad. Scho ^^,^^,,^„^^ ,91S^ 681^ 5220 pAX: (^") '^^^- ^°" 



I 



(Medical School/Residency Program) 

DUMC 3130 Durham, NC 27710 



-^■dress: 

City Zip Code 

Completing the Abstract Submission Form 

■ ■II text should be typed within tne perimeters of the box snown. Fonts no smaller than 10 points should be usea. 

■ Organize the text of the abstract as foiiows: {') oDjectives of the ourriculurn; (2) cLirricLiium dsscnpt.-on; 

(3) problems encountered; and (4) results. 



pbjective: 

"Exploring Medicine"; Cross-cultural Challenges to Medicine in the 2l3t 
^entury is a seminar designed to explore two dimensions of medicine. 
mhe first will be that of self-identification of the meaning of medicine 

tor the medical student and the second will be the meaning of medicine in 

different cultures. A conceptual framework and process to facilitate the 
Bearch for meaning in the student's individual and professional lives 
^rhich draws on art, history, literature, music, philosophy and religion 

will be explored in theory and experience. 



I 






escription: 
A multidisciplinary view of the medicine and medical care in another 
ii^ulture will be investigated in the seminar. The seminar will consist of 
series of presentations by the faculty with interactions of the seminar 

articipants. The first four weeXs are focused on answering the question 
|! of what it means to be a physician in the United States in the 21st 
jlcentury. The last four weeks will address the question of what it means 
LBto be a physician in another culture in the 2 1st century. Four papers 
|i will, be. required of each student during the course: (1) A personal history 
i^aper, (2) A medical biography, (3) A personal philosophy paper, and (4) 
'Ip. personal goals and strategy paper. At the end cf the seminar a "Spring 
i break" trip to Honduras will allow students to interface with medical 
igStudents and Honduran medical school faculty. The time in Honduras will be 
flapproximately one week with time spent at the Medical School and providing 
i^rimary care in rural Honduras. 
;i 

^Problems and Results: 

jfchis course has been very popular with students. It has been provided as 
II an interdisciplinary elective. Logistics and funding are significant 

J barriers as well as acceptance into an already packed undergraduate 
curriculum. Two video tapes ("Inter ^Jnbio" and "Viva los Gringos") have 
l| been produced that describe the stt lent's experience. Broader support 
with more sites for this cross-cultural experience is anticipated. 



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Jdress submissions to: Elena Rios. M.O., M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health. OASH FAX: (202) 690-7172 

200 Independence Ave., N.W . Room '30-8 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION. FRIDAY. JUNE 30. 1995 

59 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Interactive Health Fair 



Abstract Title: 



Presenter: Joseph Han Title: Physician in training. 3rd year 

Affiliation: Medical College of PA ' Telephone: (21p 57.6-6221 p^X: ?15) 843-6794 

(Medical School/Residency Program) 

8 25 Greenwood Ave Jenkintown PA 19 046 
Address: ' 

City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

■ Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. 



Targeting the Asian American health care we were able to gather medical schools and their students to 
develop an interactive health fair. This replicable model can provide services to the public while incorporating 
cultural competence in medical training. Due to cultural and language barriers, Asian/Pacific Americans (APAs) 
present with unique health issues and under utilization of health care. Therefore we established the Asian 
American Health Care Network, an alliance of local health care providers and medical students partnered with 
a community service organization, to organize a health fair in South Philadelphia with the goal of improving 
the health access of the Asian American community. The target audience of Cambodian, Laotian, and 
Vietnamese immigrants and refugees consist of over 8,000 Asian Americans in South Philadelphia. The goals of 
the health fair were to: educate the Asian American community about health issues, increase community 
awareness and individual access to health care services (from prevention and screening to treatment), serve as a 
catalyst in drawing attention to the health care concerns of Asian Americans, and improve the cultural 
sensitivity and understanding of health care providers with respect to APA health care needs. 

The health fair contained nine booths which addressed various health issues, such as access to health 
care, women's health, and Hepatitis B immunizations. Participants entered via an intake station, where 
translators and medical students helped orient them to the health fair program. At each station, participants 
were'screened'and provided health education by medical students, physicians, other health care providers, 
representatives from health service organizations, and translators. To provide a common thread for the 
educational and prevention activities, a health questionnaire was used as a tool to flag specific problems and 
initiate discussions about conxmon health issues. 

Certain booths attracted more participants than other booths, therefore we had to adjust the traffic flow 
despite precautions. This could be due to the fact that many participants came solely for the services such as 
immunization. Another possible explanation could be that some of the booths featured health concerns which 
participants were reluctant to address. Despite the bank of recruited translators, the excellent turnout of 
community resulted in temporary bottleneck during the fair. One other challenge was completing the intake 
forms which took a back seat in taking time to provide health education and screening services. 

Over 500 people from the community participated in the health fair. Medicaid coverage of the 
participants were eighty percent and about 20% of these belonged to a Medicaid HMO. Many of the participants 
immigrated within the past sixteen years and required translating services. The number of children under 
thirteen years of age that were immunized for Hepatitis B were 297 and individuals over thirteen years of age 
that were screened for Hepatitis B were 114. Follow-up showed that 10% of those screened were positive for 
Hepatitis B. Community organizations felt that the APA's community learned more about their health and 
stated the APA's desire for the health fair to be continued in the future. 



AridrHSs submissions to: Elena Rios. M.D.. M S.P.H. Telephone: (202) 690-5884 

Office on Women's Health, OASH FAX: (202)690-7172 

200 Indeoendence A^e.. NAV.. Room /30-B 
V.'ashing:cn O.f 20201 50 



ICULTURAL COMPETSNCE AND WOMEN'S HEALTH CURRiCULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstraict Title' Undergraduate Multicultural Health Care Curriculum at the 

! University of Wisconsin 
Preserker: Cynthia Hag, M..D. Title; Associate Professor 

Affiliation: Univ. of Wisconsin Telephone: ( 6q8-2^3-6549 p;^^^. { 698-263-5813 
f (M«dic«< SchooUResideney Programl 

i 
Addrejs: Deot . Family Medicine. 777 South Mills Street, Madison, WI 53715 

I City Zip Code 

Compi^tm9 the Abstract Submission Form 

■ AH tBM shoi^ bs typod wt&iin tfte perimeters of the box sftown. Ponts nc smaller than 7 points should be useo. 
• Orgence the text o1 the abstract as follows: (i) obfectives of ttie cum'cu<um; 12) curriculum deseriptiort: 
(3J pr^eme •neeuntertd; an^ <■*> results. 

j ( 

j Title: Undergraduate Multicultural Health Care Curriculum at the University ofWisconsin 

I 

S Abstract 

I At the University of Wisconsin (UW), we have developed a four year integrated, longitudinal, 

\ curriculum for medical students, designed to introduce concepts of health care appropriate for a 

j multicultural society. Participants will learn the rationale for developing a multicultural health care 

i curriculum, and a model of curriculum development. We will review key elements of the UW 

i. curriculum in which smdents explore their culture of origin, become familiar with interview 

I techniques that elicit culturally relevant information, wori^ with a wide variety of patients, and 

ihave the opportunity to participate in a variety of multicultural electives. From this process we 

ihope to provide medical students with opportunities to develop knowledge, attitudes and skills that 

\ allow them to demonstrate respect and to become responsive to the cultural uniqueness of each 

ipatienL 

[Objectives: 

Participants will be introduced to: 

1 . Our methods of developing this curriculum, integrating it into existing medical school 

courses, building institutional support, and engaging and updating medical school faculty; 
\2. Key concepts of the UW multictiltural health care curriculum. 

! Content: 

1. Review rationale for multiculmral health care curriculum at UW Medical School. 

^2. Describe the constitution of the curriculum committee. 

j 3. E>escribe the needs assessment (medical student questionnaire), and its outcomes. 

U. Outline key steps in developing the UW multicultural health care curriculum 

p. Identify methods of integrating curriculum concepts into medical school courses. 

1 6. I>escribe methods for biulding institutional support and plans for faculty development 

1 7. Present the muticultural health care curriculum, including selected teaching materials. 
i;8. Discuss strategies for evaluating students and monitoring curriculum implementatioiL 
c9. Discuss problems encountered and strategies for dealing with these 



[ 

AcWrws iuPmitsions to: Bena Rios. M.O.. M.S.P.H. TaitpAcna (202) 990-5884 

I OHiee en Women's Health. OASH PAX: (202)690-7172 

I 200 (ndeoendance Ava.. N.W.. Room 730-8 

t WiutMngton. O.C. 20201 

i 61 



r 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM f~ 

,bstracr Title: '^ ^ i L 

,H,„a.on.. ^lir ^cLrlc\- FulM e..o... M 9U '^W FAX: MlitJ^J /[] 



(Medical bcnooi/t-iesiaency rrogram) 



City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed w-thin the perimete-'S of the box shown. Fonts no smaller than 10 points should be used 

■ Organize the text of the atsstract as foiiows: (1) ob)ectives of the curriculum; i2i curriculum description; 
(3) problems encountered; and (4) results. 



Cultural Competency in Public Health Practice. 
Christina Harlan, BSN, MA; University of North Carolina, 
Chapel Hill, NC. 

This course is designed to increase cultural competency of public 
health practitioners working in diverse settings. Students are 
challenged to examine their own cultural backgrounds and beliefs 
and to consider the impact of those experiences on their public 
health practice. Guest lecturers include: public health 
practitioners who have worked successfully in culturally diverse 
settings, representatives of governmental agencies, faculty in 
the School of Public Health, and community members. 

Course readings are informed by the Humanities, Social Sciences 
as well as Public Health theory. Students and guest lecturers 
are asked to share both personal and professional experiences in 
ways that will challenge and help to reinterpret previously held 
assumptions. This participatory/experiential learning process 
contributes to improving culturally competent practice of all the 
participants. . .students, faculty and guest lecturers. 

This three-hour graduate level course was first offered Fall 
1994. Problems encountered appeared related to the process 
described above. Traditionally, education has been more didactic 
and some students seemed to expect more structure and clear cut 
guidelines than this type of approach provides. However, course 
evaluations were positive and students and other faculty are 
looking forward to the course being offered again next Fall. 



^.1.1re5-. submissions to: Elena Rios. M.D.. M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health. OASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JOLT 21, 1995 

be 



1 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
bstract Title: Teaching Cultural Competence — The Painless Way 



■resenter: T.n.-.. w.^K ^r--^— . ^. ^^- "^'^'e- Assistant Professor of Medical Educatio n 
Affili;,r.nnMnr.house School of Medicine Telephone: (404 752-1897/18 56 FAX: f04) 752-1064 



I 



(Medical School/Residency Program) 

Atlanta GA 30310 



Address: 720 Westview Dr. SW 



City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 
J Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 



I 



Objectives of the curriculum 

1 . Increase awareness of/ appreciation for cultural differences and their significance in communication with patients. 

2. Overcome sociocultural prejudices which may impede optimal fimctioning as a health care provider. 

3 . Introduce cultural competence issues "painlessly " by incorporating them into a pre-existing required course. 
Description 

This method of teaching cultural competence is called "painless" because the objectives for increasing cultural 
awareness and sensitivity are totally incorporated into the everyday teaching of the problem-based Ambulatory Medicine 
course. Each day, a patient case is discussed, written by the course director with particular points of emphasis. The aoility to 
do a culturally sensitive history and physical is always stressed. The course director role plays the patient and students obtain 
a history. Thus, it important to ask the right questions, but to also to ask them in a manner which will elicit useful 
responses. Not only are medical aspects of the case discussed, but also the psychosocial as()ects including cultural diversity 
issues. For example, a Hispanic woman complains of fatigue and amenorrhea which turns out to be diabetes mellitus and 
menopause. Cross cultural issues associated with that case include what is meant by the term "Hispanic" (Caribbean vs. 
Mexican vs. South American etc.); cultural norms of beauty (body weight, hairiness, body habitus); and religious beliefs and 
their impact on health behavior. Ehiring the course of each case, students form a problem list, order labs and get restilts, and 
list differential diagnoses. They may order additional procedures or consultations and throughout the case are always required 
to explain to the patient/family what is going on and what is planned next Some other cultural competence issues addressed 
in the'cdurse include^omophobia, 'ageism, dietary habits among various ethnic grotips, and healthcare-seeking/compliance 
behaviors among various groups. Cultural competence for effective communication is always stressed. 
Problems 

Few problems have been encountered because this is done "painlessly". Ambulatory Medicine is a required course 
whose focus is "real -world" primary care general internal medicine. The main "problem" is that, taught in problem-based 
style, 4-6 students is optimal. With significantly more or less, discussions either tend to bog down or to become unwieldy. 
Results 

Results have been excellent. Students consistently give the course high ratings both for the hard-core academic 
content as well as the "extra" content. The course director has "planned" digressions in which students are allowed to go off 
on what they perceive as tangents. However, the course director knows that discussions of particular cultural issues always 
come up during certain cases. Students appreciate being able to explore these issues with a non-judgemental course director 
who clearly values cultural diversity. Students have made suggestions for incorporating even more cultural issues into some 
of the cases, or have offered scenarios for additional cases. Qearly. their interest has been stimulated. "Sneaking" cultural 
competence into the curriculum has been effective because students do not have the chance or desire to tune the messages out. 



] 
I 



JAH-lress submissions to: Elena Rios, M.D.. M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health, OASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 730-B 
Washington, O.C. 20201 

63 
DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 



CULTURAL COMPETENCc AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 



ABSTRACT SUBMISSION FORM 
Abstract Title: The Indian Heal th P^^rhw^v ^nn n^m'vp irv^.ir-^n 



Presenter'. 
Afliliation: 



Dr. Gerald Hill 



University of mn 



(Madica] Scheel/J^MitSancr Pregrmm) 



„__^.^ Title: Director, Ce nter for American T nri 

& Minority Health 
_ TBJBphcne; ^13626^2075 FAX; <513 82^-0820 



3 



Addra$«: 2221 University Ave. SE Suite 100 Minneapolis, MN Sb414 

City 2iQ Cod« 

Cempi«tino th« Abstract Submission Fonn 

8 All tast jneutd b« ryo»0 wrtf^n rf^* perimtrsn ef the box ihown. Fonts no scalier than 10 points shouie b* uttd. 
> C'SaniSt tM Ttxt Of tnc abstract as fallows: (1) objactnres a< th« cwrricwktm: (2) eurricukm dtcchrtjon; 
[3) prdblamt tncountarad; and (•*» result*. 



I 



Objoctives: The overall goal of Indian Health Pathway at the U oi MN Medical Schools is io provide 
medical education and cumculum to appropriately train American Indian students to pracJce western 
medicine in the Indian communities. Objectives include: 

1) Provide education to American Indian medical students and others on the health need2 of American 
Indian and Alaska Native people. 

2) Provide education within a social and cultural context of care for AI/AN people. 

3) Provide training on interaction between Western and traditional medicine of AI/AN communities. 
4} Provide appropriate and culturally aware role models for AI/AN medical students. 

5) Maintain or increase the interest in careers of AI/AN health for AI/AN medical studenti.. 
Curriculum: 

Oidaaic courses in the American Indian and Alaska Native health care system utilizing the community 
or oriented primary care model. Seminars in Indian Health are offered throughout the first two years 
of medical education. First year students perform their Family Medicine clinical rotaHons at the Fon 
du Lac reservation. Second year students serve on rural reservations in MN.WI.and the Dakotas. Third 
and fourth year students participate in Indian Health Service clerkships as well as a Traditional Indian 
Medicine Clinical Clerkship. Students participate each year in the Association of American Indian 
Physician's annual meeting and Health Conference to meet role models from various speraltles, learn 
more about current issues in Indian Health, and innovative strategies for caring for Indian people. The 
Traditional Medicine component is also a part of this annual meeting. This is held in cunjunction with 
the annual meeting of the Association of American Indian Medical Students, allowing the students to 
interact with other AI/AN medical students from around the country. Students also participate at least 
once during their four years in the Cross Cultural Medicine Workshop offered by the A.A.I. P. for 
American Indian medical students. This workshop focuses on the interaction between traditional 
Western medicine in the reservation setting. 
Results: 

Since 1991, the U of MN has increased the number of American Indian and Alaska Native medical 
students from less than two per year to an average of over ten per year. There are now a total of 44 
AI/AN students at the U of MN which is approximately 10% of the nation's total of AI/AN medical 
students. The most valuable components for Increasing student interest in practicing in Native 
American communities are the A.A.I. P. annual meeting, the Traditional Medicine component, and 
interacting with other American Indian and Alaska Native physicians and medical students. Overall 
there has been an increase in student interest in working within American Indian and AlasKa Native 
communities at the conclusion of their training. 



A4Jrn*< auDTMtiien* to: £!««• «ioo. M.O., M.SP M, 

CHica an Womann H««ith. CASH 



Teia«fton«; 
rAX: 



(202) aso-jesA 

I202i bs,C-7l7l 



64 



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I 

■ CULTURAL COMPETENCE . - <'H CURRICULA IN MEDICAL EDUCATION 

I A :?>UBMISSI0N FORM 

A Medical School Coriculum in American Indian Health; 
ADJXract ntle: 



IThe Indian Health Pathway Track 
fea«nter: Vfalt Hollow. M.D. , M.S. pitlc: Director, Native American Center of Exc el 1 er 

t ....>..„. ^pi^ f JSr^^^'^2^--^^^^^'"^^°" Telephone: ^06 ) 685,-248_9 PAX: (20^ 541-9063 
(M«dtB«i Schooi/R«tidtRey Program) 

rfi^res^: UWSOM Native American COE. Box 357430 Seattle.. WA 98195 

City ZiD Code 

Complctfftg th« Abstract Submission Form 

m All tixc thouid be typed within tfte penmetirt oi the b«x jhown. Fonts no kmali«r th«n 1 pcimi should &• used. 
!■ Organize the text o< trw aejtfecx as toilo.ws: (l) ob»ect»v«e of the cuniculum: (2) curriculum da»crtptJon; . . 

(3) probltms •rwauntercd: and (4) resultt. 




Current medical school education is very complex and comprehensive in the 
1990*8. The average American medical school, on the other hand, teaches little, if any, 
infonnation about American Indian health issues. The University of Washington School of 
Medicine (UWSOM) has developed an American Indian Curriculum. The goals of this 
program are several fold: 

a. Ensure that all UWSOM students learn about American Indian health 
issues. 

b. Introduce an Indian Health Pathway Track that lead to graduation 
- — certification documenting special expertise in Native American health 

issues. 



I 
I 

■I 
II 

III c. Incorporate Traditional Indian Medicine (TIM) into the curriculum and 

i; aliaw students to learn from and work with traditional Indian healers. 

I! 
,» 

- ". d. Oflfer required clerkships in tribal clinics, Indian Health Service (IHS) 

J I; hospitals and other Indian health programs that will broaden the student's 

i: experience in Indian health. 

I ll e. Coordinate teaching activities with the Association of American Indian 

Physicians to provide training opportunities to American Indians from 
1 ij other medical schools. 

; The Indian Health Pathway Track will be described and experiences encountered 

I! to date will be shared. Results of this unique curriculum program will be demonstrated 

airmo with f itiire nositivfi imnacts on Indian health status. 



along with future positive impacts on Indian health status. 



I 



.»»-%.««.ons ra; Elena Riot. M.O.. M.S.P.M. •!'«»«onone: l202l 690-5884 

PAX- :2C2) 690-717: °^ 



r 

CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM || 

Traditional Indian Medicine - How Does It Interrelate to Modern Western Medici 
ADSiract Tule: — 

Walt Hollow. M.D. , M.S. -, , Director, Native American Center of Exc^ 1 

A,«li.,.on: y8ftii8f^??yHgSliJ1Sr"9^°" T.upH ^6 i 685.2489 FAX: .206 543-9063 ^. 

(Mtdie^ Scrwol/floaidtncy Proif*«) 

ArtrtfP^«: UWSQM Native Ainerican COE Rnx 357430 SPflttlfi. WA 98195 _ [\ 

~^ ' City Zip Code 

Complating th« Ab«\r»nt Submission Form r r 

■ AU xe«t thogid b« typed wrtfwi tne pcnmtw* oi tne Dox shown. Fonts no »m«u«< cfwA 10 points i^ou^d b« uaed. 
• Or^ariam th« text of tne tottricx •« ♦oUor'*: H J objective* of the cumculum: (2) curriculum dMcnption; I 

(2) BfoWemt encounui-ed; »nd (4) nastita. 




rraditional Indian Medicine wa5 the health care system utilized by American 
Indians prior to the discovery of the American continent by Columbus over 500 years ago 
for ALL of their health problems. Dramatic cultural changes occurred among Indian 
tribes ar a result of the establishment of the United States and the colonization of the new 
worid. What is Traditional Indian Medicine? How prevalent is it in the 1990's? How 
does it <'onfiict with current modem western medical therapies? Is there room for j 

collaboration among these seemingly diametrically opposed approaches to current f j 

American Indian health problems? How can a modem western practitioner collaborate ^ 

with current traditional Indian healers? Is there any data for the usefulness of Traditional | 

Indian Medicine in treating current Indian health problems? I 

Dr. Hollow will discuss the above issues and allow for audience participation in the | 

exploration of these topics. This will be done in the context of describing the Traditional 
Indian Medicine clerkship offered at the University of Washington School of Medicine. 



Addr«. .uomi.s.on, tn: Sl.n- «.0.. M.O.. M.S.P-H. Toi.oftone: (2021 «0-5a84 

Office on women-: Health. OASH FAX; t202) 890-71 7. 



=^t 



w w Aoom 730-6 



66 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 



Ao?^' r-!' [ Title , 



Teaching Pediatric Residents the Impact of Cultural Diversity on the 
Medical Encounter Roben IL Kamei, MD, Helen Loeser. MD, Jane A. 

Berazweis, PhD, Elena Fuentes-Afflick. MD, MPH, Carol A. Miller. MD. 



n Roben K. Kamei, MD t»i«. Director, Pediatric Residency Training Proeram 
P'tsservor: l 'tie. ' ° 



AtW,at,on: UC Sail Francisco Telephone: '■*'^' '*^6-0987 ^^^^ (415)476-4009 

(Medical School/Residency Program) 



Address; 



Box 01 10, Depanment of Pediatrics, UCSF, San Francisco, CA 94143 



City Zip Code 

Completing the Abstract Submission Form 

■ All text should be tvoed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

■ Organize the text of the abstract as follows. (1) objectives of the curriculum; (2) curnculum description; 



J I J> \ .... .u- 



Teaching Pediatric Residents the Impact of Cultural Diversity on the Medical Encounter 

Goals and Objectives ; In appreciation of the tremendous diversity in the patients we serve, we developed a workshop 
to educate our ped'^fnc residgjois to the impact of patient diversity on the medical encounter. We presented a training session 
to 20 f)ediatric residents. Our goal was to increase their awareness of the role that culture, their own and that of their patients 
and colleagues, has on the clinical care they provide. We planned to achieve this goal with our residents by: a) reflecting on 
their culture, and perceived differences and commonalties with others; b) understanding and acknowledging some of our 
stereotypes used to view the world around us; and c) discussing culturally sensitive ways of caring for patients in difficult 
clinical situations. 

Curricular Design : The workshop consisted of 3 sections. Participants staned in small groups working on questions 
designed to elicit self descriptions and personal experiences. Common themes were then explored in one larger group. In the 
second section, slides depicting a wide range of diversity of patients and family structures were shown. Each slide was 
introduced in the context of common primary care encounters. Examples of scenes were: a lesbian couple with a baby, a 
racially mixed family, teenagers dressed in "grunge" wear, African-American grandparents with small children, and an extended 
Asian family. Participants were asked to react to the stereotypes they portrayed, with permission given to contribute what 
"others" might say. In the flnal section, 2 patient cases were presented: the first dealt with socioeconomic class and family 
values; the second considered provision of primary care to a family with a challenging and unexpected maternal history. 

Sfrehgth s and Prohlem.s Rncountcred ; Perhaps the greatest strength of the session was derived from the participants 
and the facilitators who represented a diverse mix of individuals of differing gender, ethnic and cultural backgrounds, and sexual 
orientation. Furthermore, all had spent a year working together in the medical setting. We held the training session at a time 
when all residents were together on the last day of the year, so distraction may have been a problem. In addition, when 
viewing the primary care encounters, it may have been difficult for residents to disregard their medical training and focus on 
their personal biases. 

Results ; We surveyed our 20 residents and found that the topic of cultural diversity was important to 19, somewhat 
important to one; no resident thought it was unimportant. When asked about the role culture plays in patient care. 16 of the 
20 residents found it to have a critical or important role. 4 thought it had a less important role; no resident thought it had no 
role. Although many residents felt it is an important topic to be included in medicaJ education, the majority of residents (12) 
thought it was inftrquently or never raised in teaching. Only 8 acknowledged any previous formal training or background in 
developing cultural competency. 

Conclusions ; Our pediatric residents were active participants in the workshop on diversity, and most understood the 
importance of the issue on patient care. Despite it's importance, it is not often formally discussed. A number of residents 
asked for other ways to incorporate this teaching further into our curriculum. 



Address submissions to: Elena Rios, M.D., M.S. PH. Telephone: (202) 690-5884 

Office on Women's Health, OASH FAX (202) 690-7172 

200 Independence Ave., N.W., Room 730*6 
Washington, O.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30. 1995 6 7 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 



At 

Pf 



ABSTRACT SUBMISSION FORM 

Abstract Title: ^^J;^^^ ^^^ TEACHING B IAS-FREE COMMiiNTrATinM <:vtttc 

^AMWr^^vTcoKT Km ACADE>fIC ASST., WOMEN'S HEALTH EDUCATION PRCK 

Presenter: SANDRA p. L!^/ison. MD Title; director, women's health FnnrATTOM PPnr, .^/'TI 



LUCIA BECK WEISS PROGRAM MANAGER , WOMEN ' 

Affiliation: MEDICAL COLL OF PENN & Telephone: (^TJftA?^;/.?^^ FAX: 1^ 

(Medical School/R9«id«ncv Program) 
HAHNEMANN UNIVERSITY 



HEALTH EDUCATION PRC 

I 



Address: 33QQ HENK7 AVKNliE rniLADCLPHiA pa wrzo 

City Zl;iX;ode 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be usad. 

■ Organize the text of the abstract »s follows: (1) ob^ctives of the curriculum; (2) curriculum description; 



C (3j problems encountered; and (4) results. 



Objective: To teach students, educators and healthcare providers bias-free communication 
skills necesu'ary for improved health care dehvery to all patients. 

Curriculum Desaiption: Because medical education and health care delivery rely heavily 
on open communication channels between educator and student as well as between 
physician and patient, the use of inclusive language improves the quality of healthcare by 
granting equal respect for ail parties involved, regardless of gender, race or class. 
Language has thft power to create pcrcqptions, to secure ideas and to mediate change. With 
this in mind, we wrote the Medical College of Pennsylvania and Hahnemann University 
Guide to Bias-Free Communication for Students, Educators and Healthcare Providers. 
This guide is used in conjunction with role play vignettes, interactive theater presentations, 
videos and other developed educational materials. This program is a multidisciplinaiy 
effort, thentby insuring the remforcement of bias-free communication throughout the 
medical school curricuJum. 

Pf&blents: The obstacles that may be anticipated in the inq>lementation of this program 
include: 1) resistance to curricular change, 2) accusations of thought pohcing and 
institutionalized political correctness, 3) fear of punitive action when speaking freely and 4) 
feelings of being deprived of academic freedom. 

Coals: The diversity of our medical community warrants the use of inclusive and 
appropriate language in order to validate and afford equal respect for the differences in 
backgrounds and experiences of health care providers, staff, patients and students. 
Because attitudes learned previous to and during medical school are often carried into health 
care dehve^^ recognition of our blind spots and the accurate depiction of people are 
necessary steps to effective health care delivery to all patients. 




^flfiresa submissions to: 



eiuna Rios, M.O . M.S.P.H. 

Office on Women's Health. OASH 

200 Indeoendence Ave.. N.W.. Room 730-B 

Washington. O.C. 20201 



Telephone: 
PAX: 



(202) 690-5884 
(202) 690-7 1?2 



DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. 1995 



68 



CULTURAL COMPETENCE ANC WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
experiental rather than didactic approach 
Abstract Title- Teaching cultural competency to first year medical students bv an 

Present'jr: B U.K. Li MP Title-. Associate Professor of Pediatrics 

Affiliation: Ohio State Univ. relephone: 614) 722. 3450 FAX: (614 722 3454 

(Medical 5chool/Hc3idenCY Prgaram) 

700 Children's Dr 
Addres*.: Division of Gastrcenterology Columbus, OH 43205 

Children's Hospital ^'^ Zip Code 

Compt^ttng xhm Abstract Submission Form 

■ All t«x: should betyotC wuhin tht oerime^trs of the tox shown. Fonts no smallar man TO points shouJd tm ua«d. 

■ Organize the te*t of the abstract 4s follows: (1 1 objecovas of ihe curriculum; (2) cufficulum deacriptjon. 

(31 etoaimms sncountered: and <■*) resuits. 



The development of an effective curriculum design to teach cultural competency to first 
year medical students is a current challenge in undergraduate medical education. 
Objectives: 1) To contrast standard American with other ethnic world views and demonstrate 
their impact on health care delivery. 2) To sensitize the medical students to the effects of 
bias and racism towards patients and health professionals of differing racial and ethnic 
backgrounds. 3) To develop basic strategies to deal with patients of differing racial, ethnic 
and linguistic backgrounds. 

Curriculum design: Three hours of plenary session and ZVi hours of small group discussion 
are dedicated to the 'Cultural diversity in medicine' portion of the Medical Humanities and 
Behavioral Science Course for first year medical students. An evolving curriculiun has 
included the following plenary components: 1) tabulation and presentation of medical student 
cultural attitudes towar(is racial and ethnic minorities, 2) an overview on the changing 
demographics of American societ}/, 3) presentation on contrasting cultural values and how 
they affea clinical practice, 4) viewing the 'Two Colors' NBC documentary on racism, 3) 
panel discussion of personal experiences by physicians of both racial and ethnic minorities 
(including immigrants). Small groups (20 students) discussed personal experiences with bias 
and racism and videotape vignettes from 'Racial and cultural bias in medicine' (American 
Academy of Family Physicians). Training sessions for physician and behavioral scientist 
facilitators were held prior to the small group sessions. Future plans include the development 
Qf .a_videQtape_depicting misunderstanding and bias in a clinical encounter with a SE Asian 
patients and showing strategies to address these problems from both patient and professional 
perspective. 

Results/Problems: Feedback from students indicate that the 'cultural diversity' module is 
more effectively taught as a 'sensitizing' session than in a standard didactic format. The 
professional panel discussion, the documentary and the small group discussions were the most 
received components - presumably because are the most experiential and engaging exercises 
for the students. Students are very sensitive to having diverse ethnic and gender 
representation on the panel. Future plans include assessing student cultural attitudes both 
before and after the 'cultural diversity" module to see if an effect can be measured. 



AMrtt*< tubmiisions to clena Rios. M.O , M.S P H. Teltonon*; (202) 990,588^ 

OM'Ce on Wom«n '. HMith. CASH FAX: (202) 690-71 7 Z 

20C inaeoenoence Ava.. n w.. Room 730-8 
wasr>ingtcn, C 20201 

DEADLINE POR SUBMISSION AiBfcf, JgL!t>ai. l^lT 



69 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION p 

ABSTRACT SUBMISSION FORM 

Abstract Title: a Mnltinultural Cor^mMnitv-Oriented Pr im a r y Care Fellowship Program for Family Physicians ^ 

Presenter Pnh.r. n I ike. M.D.. M.S . Title: Associate Professor of Family Medicine 

rresenier. ^ ^ ^^^ ^ ^.^^ .^^^ ^^ ^ Multicultural Communitv-One nted Pnmary Care Fellc*^ 

.fflinti— ■ ■^>1^M.l.RnhPrt Wood John son Medical School Telephone: (908) 235-7662 Fax: (908) 246-808 4 
(Medical School/Residency Program) I 

Address: i Pohart Wnnri Johnson Place New Brunswick, N.J. ^8£02^ 

. Qj^ 2ip Code 

ComDJeting the Abstract Submission Form , ,^ u 

■ All text should be typed wrthin the perimeters of the box shown. Fonts no smaller than 10 points should be used. 
. Organize the text of the abstract as follows: (i) objectives of the curriculum: (2) curriculum description; f 

(3) problems encountered: and (4) results. 



Overview The UMDNJ-Rcberi Wood Johnson Medical School Department of Family Medicme's mnovative 
Multicult ural Community-Oriented Primary Care (COPC) Fellowship is designed to equip family physicians with the | 
knowledge, skills, and attitudes needed to provide culturally sensitive and competent health care to diverse population 
groups. . 

ObiectivesoLtheCmTicuh^ By the end of their training. Fellows are able to: (1) describe the changing 
demographics and epidemiology of health and illness problems affecting various population groups in the United 
States (2) identify important national, state, and local health promotion and disease prevention objectives for different 
minority ethnic, and disadvantaged populations: (3) provide more culturally sensitive and competent cUmcal care and 
preventive health services to individuals in the context of their families and commumties; (4) appreaate the 
heterogeneity that exists within and across ethnic/cultural groups and the need to avoid generalizing and stereotyping; 
and (5) express respect and tolerance for sociocultural differences, and their value m a pluralistic society. 

r „rrir..ltini Description: The Multicultural COPC Fellowship is based on a two-year longitudinal core curriculum, 
consisting of integrated didactic clinical, and community-based learning experiences. Fellows pursue a 45-credit 
M P H degree with a concentration in Family Health from the New Jersey Graduate Program in Public Health. 
Fdlows are placec^at clinical sites that provide care to multicultural populations, and have an opportumty to 
oarticipate -n a wide variety of community outreach activities. Fellows also receive focused multicultural training 
including a series of workshops/seminars on "Cross-Cultural and Minority Health," ethnosensitivity and cross-cultural 
communication skills training, precepting of clinical encounters for cultural competence, and participation m other 
multicultural educational activities. ^ 

Prnhl«>ms Encountered : Challenges that we have faced and successfully dealt with have included recruiting a Fellow, 
developing a Multicultural Educational Resource Center, integrating multicultural perspectives into the existing 
medical education curriculum, and training faculty and staff about culturally competent health care. Challenges that 
remain include developing a "portfolio" for documenting multicultural clinical experiences, further developing | 

academic-community partnerships, and identifying continued long-term funding for the Fellowship. 

Results- Our first Multicultural COPC Fellow, a Native American female family physician, will share her personal 
ilwTe experiences in this Fellowship. She has given workshops and lectures on American Indian Health Care and 
Women's Health issues to a variety of national, state, and local audiences, helped to develop multicultural curricula for 
residents and medical students, and participated in a "mock legal trial" relating to cross-cultural healing. A formative 
evaluation of the Fellowship program will also be presented, including a discussion of its impact on multicultural 
education and residency training at our medical school. 



Address submissions to: 



Elena Rios. M.D., M.S.P.H. Telephone: (202) 690-5884 

Office on Women's Health, CASH FAX; (202) 690-71 72 

200 Independence Ave., N.W., Room 730-B 
Washington, D.C. 20201 70 



CULTURAL COMPETENCS AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title- ^^^^^ i-lajjj^zjjLCU-u (Ui/fiAr^ across f^C Cutrir..Ld'.(jj7o . 

ui-H<J eW S Coofci.r.c-trrr oj i.ruaint '^f-^-tlop^-nCfU 

'^r-inz-L A hums School of n^diCtniy 

AHSia^on: ^t^S^-^ "f ^aa^a.'> a/ ;^^^ Telephone: (e^)^^^-^5g^ PAX: ^g^^^^ .^^/ 

(Medicai 5choof/HeaJ«ie»xv Programl 

Address- i^(^0 ^^f^^'O-'cG^ ^^^ . g^/g^^ g'-ig'^' Lionel ulu '%ezz. 

city Zip Code 

Completing the Abstract Submission Form 

a All text should be typed **'thjn tfw penmewrs o» tne box sftovwn. Foms no smaHer tfwn TO points shnid tie used. 
■ Ofganfee The text of *• absTract as ♦oflows: HI objectives o* ffw cumcoKim: (2) currtculwn dascnmion: 
p) probtems encowntarad; and (4) resists. ■ — 



r 



1 . Objectives of the Curriculum 

Hawaiian culture is integrated across the curriculum at the John A. Burns School of Medicine (JABSOM). 
The basic values of the native Hawaiian culture are integral to the study of medicine in the JABSOM 
Problem Based Learning (PBL) format. PBL stresses group learning, sharing, problem solving and 
consensus development. Pertinent concepts include: 

Aloha - Good feelings (love) toward one another 

'Ohana - The importance of the family 

ji Lokahi - Hamnony; working together to solve problems 

Kokua - Helping one another 



K 



ij 2. Curriculum Description 

a a. Through the Native Hawaiian Center of Excellence, Hawaiian Health problems have been introduced 

II in to the first year curriculum. 

I b. Dr. Kekuni Blaisdell offers an elective to fourth year students in native Hawaiian healing | 

r; c. Native Hawaiian traditions are important components of the JABSOM Program. \ 

^ 1 . The academic year begins with an Open House for families !' 

jj 2. The year ends with a luau (traditional native Hawaiian feast) that the first year class presents to the 

jj graduating fourth year class. 

t 3. The convocation in May is in addition to traditional commencement. Students thank the { 

I? r person(s) whoTiave helped and supported them most with a maile lei. This is a touching native \ 

i Hawaiian ceremony. i 

ji 3. Problems j 

We are continuing to introduce and refine native Hawaiian health problems into the PBL format. The i 
Center of Excellence is promoting this endeavor. a 

\ A. Results 

'Iwalani Else and I are eager to share our unique, diverse medical community with you (ethnic makeup 
form attached). Our Center of Excellence is proud to promote the native Hawaiian tradition within the 
John A. Bums School of Medicine. 



J 



AddfW!5 «utmissions '.z: Sena ffios. M.D., M.S.P.H. Telephone: f2021 690-558A 

Otfrca on Womsn's Heaitn. OASH FAX; 52021 690'71 72 

200 lnoep«ndHnca Ave.. N.W., Room 730-B 
Waxnmgtan.- O.C. 20201 



OEADUNEFOITSUBMISSION: ffllC»vr,liSM^^1ddS -A^y^ 



71 



/ 



REVl'sKi) Au^us: 7. 1995 



UNIVERSITY OF HAWAH SCHOOL OF MEDICINE 
1995-1996 Enrollment-Ethnidt5' Breakdown 



ETHM arv 


1 IS r YEAR 


1 2ND YEAR 1 3KD ^TAR 


! 4THYEAR 


I TOTAL 1 


American Indian 


1 u 


10 11 


1 


1 1 


Anr^nian 


1 1 


1 





1 


1 


Cambodian 


i 


(3 





1 1 


1 


ducasian 


O 


10 1 11 


1 8 


35 


Chaniuao 


1 


1 1 i 


1 


3 


Chinese 


12 
(R=l) 


4 


V 


5 


30 


Eait \i idian 


1 








i 


1 


Filipino 


9 


5 -S 


i 1 


18 


Hawaiian 


5 


9 1 6 


1 8 


2S 


Hawaiian/ 
African-American 





1 1 
1 





1 


Hawaiian/ 
American Lidian 





1 





1 


Hawaiian/ 
Fiiipinu 





1 1 

1 





1 


f^Danic 





! - 








JaDansse 


12 


14 1 18 


Z3 


ei 


Japanese/ 
Okinawan 





5 








5 


Korean 


1 


3 1 2 





6 


Malavsian 





1 


1 





1 


Maiav5:ian Indian 


! 


1 i 





1 


1 Maori 


1 


1 





1 


Mexican American 


i 1 


1 





2 


Miconesian 


Di 1 


•1 1 •I 


•1 


4 


Mixed /Other • - 
Asian 


6 


5 1 


1 


12 


Mongolian/ 
Russian 





1 





1 


Okinawan 


n 


2 i - 





2 


Samoan 


11 


i 




2 


Taiwanese 


1 


1 





1 


Tnai 





1 


1 


1 


Vietnamese 


1 


1 1 





2 


TOTAL 


57 


63 j 57 


52 1 


229 



Miaunesian; 
R=Re turning 



□Palauon 



^Marshaliese 



'Yapese 



12 



tiaitoa: 



■cultural competence and wom£W's health curricula in medical education 

abstract su8missjon form 

'JIt Title: Beyond the Rhetoric: Culcural competency into practice 



efler: 



1 



Barbara Marque. 



MP!! 



Title: Assistant Chief. Office of Multicultural Health 



Calxfornia Department of 



Telephone: ^ 91,6) 322-6868 p^^ ,(91,6) 32^-7763 



I 



ress: 



(Medrt::3< School/Residency Program) 

PO Box 942732, MS 675 Sacramento, CA 94234-7320 



ipBttog the Abstract Subm'csslon Form 
tex: should be tvcs^ within the perir^M^:^r5 of 
nizc 



City 



Zip Code 



the box shown. Fonts no srnalte.' than 1 points shocrfd be used, 
gonize the text of the abstract as followj; (1) oojec'Jv«s of che curnculum: (2) curriculum description; 
pUslems encountered: and K} results. 



I 
I 
I 
I 
I 
I 
I 
I 
I 



OBJECTIVES: California' population is becoming increasingly culturally and linguistically diverse. Indeed, the 
diversity of the population served by the Department of Health Services (DHS) and its local panners is growing 
much more rapidly thai iht diversity of the pool of health care providers. As a result, provider/consumer 
interactions in health care settings are more and more likely to occur across cultural lines. These cross-cultural 
interactions require flic application of new information and skills in order to acliieve the desired outcomes. In 
1994. the state health dspanmem embarked upon a systematic and organizational -wide effon to define and 
operational ize cultural comDetency for its programs, practices and policies. 

DESCRIPTION: Under the direction of the Office of Multicultural Health, and in collaboration with the Office 
of Women's Health, an internal workgroup composed of representatives from public health programs, Medi-Cal 
(Medicaid), audits/investigation, contract management, personnel and other imits was convened. This workgroup 
has provided guidance on tne development and adoption of an operational definition of cultural competency and 
the associated guiding principles, self-assessment tools, how-to- guides and other resource materials. These 
efforts have been largely based on the cultural competency continuum described in Towards a Culturally 
Competent System of Care (1989). Tlie DHS has initiated and plans to continue its interaal assessment of its 
level of cultural competency-both its strengths and weaknesses-by different program units. The resultant 
materials and tools are to be field-tested and reviewed by focus groups of DHS staff, health providers and others. 

PROBLEMS: The timeline for the development of this program has been greatly underestimated and the 
evaluation aspects havi proven challenging. 

RESULTS: The workgroup has reached consensus on a definition for cultural competency and 10 associated 
principles. Additioiially, self-assessment tools have been drafted and arc ctirrently under review The broad 
dissemination and implementation of the materials and training will follow. The utility of these materials and 
tools will also hopefully be appropriate for health professional training programs, hospitals, local health 
departments and other agciicics. In the quest to better serve ail population groups and to be culturally competent, 
it is critical that an organization's efforts are (1) systemwide; (2) focus on both programs and policies; and (3) 
based upon an asses ;meni of the organization's cultural competency successes and barriers. 



Co-Authors: Kim Yeafeer. MD, MPH, Chief, Office of Women's Health/CDHS 
Caiviu Freeman. Chief. Office of Multicultural Health/CDHS 



■-«;< submissioAS to: Elena Ros. M.D.. M.S.P.H. 

Office on Womcn'.s Mealu'-.. OASH 

200 >p>dep«ndeftce Av«.. N.W., Boon^ 730-6 

WAshiogton- D.C. 2020T 



Te^epnor*: 
FAX: 



(202) 690-538^ 
<202) 690-7T72 



I 
I 



DEADLINE FOR SUBMISSION: naJ)AJ. JTJLT 21, 1995 



73 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM j [ 

T'Tif*- An Introduction To Culture and Cross-Cultural Comnunication in the Me dica 
Abstrrict line. — Encoum 

p ^.^g^. Martha A. Medrano, MP Title: Assistant Professor 



Affiliation: 



Ux-HSCSA Telephone: ?^0) ^^'-^"^^^ FAX: ^^0^^61,5381 



(Medical School/Residency Program) 



Dept. of Psychiatry, UTH SCSA> 7703 Floyd Curl Drive, San Antonio, TX 7828 4-77< 

City Zip Code 

Completing the Abstract Submission Form 

■ AH text should b^ typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

■ Organize the text yf the aoatract as follows: iD objectives o< the curriculum; <2) curnculum descr.ption, 
(3) problems encountpred; and (4) results. 



1) Lecture Objectives; (1) Describe patient's various perspectives and expectations regarding 
health care services. (2) Describe how culture and cultural perspectives may affect behavior, 
values and beliefs. (3) Define the terms culture, ethnif^lty, ethnocentrism, accufturation, and 
cultural competence. (4) Describe the characteristics of western medicine that define its 
unique culture. (5) Name communication concepts important in cross-cultural patient 
interactions. 

2) Curriculum Description: Community Representatives gave a 20 minute presentation on 
unique aspects of the health care of N/Jexican-American, African-American, Asian-American and 
Native American patients. 

3) Problems Encountered: In selecting community representatives to discuss unique cultural 
perspectivos in the major ethnic groups in our community, selecting representative to address 
the Asian-Pacific Islander group (13 different groups are represented in San Antonio) was the 
most challenging. 

4) Results; The presentation has been well received by the first year medical students. There 
was alot 01 interest from the student to talk to the community representatives after class about 
cultural issues. There was positive wntten feedback from both course director and students. 



AHHr«sE subm.ss.ons To: Elena Rios M.D.. MS PH. Telephone: (202) 690-5884 

Oft.ce on Women's Health. GASH FAX. (202) 630-7172 

200 Ir^dependence Ave., N.W., Room 730-8 
Washington. D C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30, 1995 



74 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: Clinical Preceptor Training for Students in a i.onqitudinal Cross-Culturai Education Program 



Presenter: Ana E. Nunez. MD 



Title: Assistant Dean of GeneraJism and the Community 



Affiliation: Med Col PA and Hahnemann Univ . Telephone: (215)762-7296 

(Medical SchcwI/Residency Program) 



FAX: (215)762-8654 



Address: Hahnemann Univ. MS 440. Broad & Vine St. 



Philadelphia PA 

City 
Completing the Abstract Submission Form 

■ All Text should be tvped \Mthin the penmters of the box shown. Fonts no smaller than 10 points should be used. 
s Organize the lext of the «bstT?cl as follAws < I ) ohiectlves of the cumcuium: (2) curriculum description: 
(3) problems encountered : and (4) results. 



19102-1192 

Zip Code 



Cumcular Objectives: understand the definition of a culturally effective educator and clinician in the medical 
encounter, demonstrating strategies to avoid stereotyping and illustrate positive aspects of diverse patients; increase 
awareness of cross-cultural nonvertal communication skills; gain comfort with the "uncomfortable" issues of difference; 
understand the approach to increased awareness of difference with cultural values and beliefs; generate case vignettes 
of common clinical examples in underserved clinical sites; address challenges students may bring to preceptors. 

Students trained in our longitudinal integrated cross-cultural cumcuium became sensitized to their lectures and 
topics (assessment of health care risks based upon ethnicity, for example). In addition to developing discussion 
sessions, a program to train clinical preceptors with whom the student would be woricing was designed. This cross- 
cultural wortcshop focuses on the issues and skills students need for optimal patient encounters in clinically underserved 
sites . Included in this interactive session is a worthing definition of diverse which is.- 'anyone who is not you'. This 
definition highlights the fact that enhanced cross-cultural interactions require an awareness in both the clinicians culture 

Iand the patients. This workshop describes a six hour seminar consisting of two sessions, each lasting three hours.The 
optimal group size is twenty participants or less. The curriculum is based on adult learner principles and is highly 
interactive and experiential. Participants are encouraged to evaluate their individual approach to understanding and | 
interacting effectively with culturally diverse groups. Video analysis of films created by the developer as well as 
commercially available videos are used. These enable the participants to enhance their skills of changing the cultural 
context so as to understand the communication. In addition to cross-culturalism knowledge and skills, preceptors are 
instructed on delivery of feedback to students. Common cross-cultural conflicts were also highlighted so that mentors 
were more effective in their role of Iroubleshooter'. 



Problems Encountered: 

i_ogiaiic apiu resGufCc anCCaiion issues are me main prouicrrt in s smsn group sernirisr lOrmai, cspeciany scarcuy Oi 
trained facilitators. Leamer resistance by clinicians to this topic required special attention. 

Results: 

The first group of eighteen preceptors (physician and physician assistants) were trained. Post session evaluation 
reported that the preceptors wanted more information about specific populations, more video-vignette analysis of 
cases. Student feedback is pending. Specialty types trained included clinicians in the fields of primary care (general 
internal medicine, general pediatrics and family medicine), addiction medicine, medical and surgical sut)specialties. 
The ethnic composition played an important role in the groups with heterogeneous more able to "test hypothesis" of 
diverse people than homogeneous groups. Video-vignettes serve as powerful affective triggers to discuss the personal 
impact of diversity and medical education. 



Address submissions to: Elena Rios, M.D., M.S.P.H. 

Office of Women's Health. OASH 

200 Independence Ave., N.W.. Room 730-B 

Washington, D.C. 20201 



Telephone: 
FAX: 



(202) 690-5884 
(202) 690-7172 



DEADUNE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title "Looking Within To See The Outside Better": A Model for Cross-Cultural Effectiveness Education 
Presenter Ana E. Nunez, MP Title: Assistant Dean of Generalism and the Community j 

Affiliation Med Col PA and Hahnemann Univ . Telephone (215)762-7296 FAX (215)762-8654 

(Medical School/Residency Program) 

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Address Hahnemann Univ. MS 440, Broad & Vine St. Philadelphia PA 19102-1192 

City Zip Code 

Completing the Abstract Submission Form | 

■ All Text should be typed within the pemnters of the box shown. Fonts no smaller than 10 points should be used ^ 

■ Organize the text of the abstract as follows: (1) objectives of the cumculum; (2j cumculum description, 
(3) problems encou j itcred , and (4) results. 



Curricular Objectiveb understand a broader definition of diversity and key terminology, enhance understanding of the 
role of small group teaching of skills using multi-media, describe essential goals and challenges in education in this 
area; enhance cross-cultural nonverbal communication skills; understand the approach to increased awareness of 
difference with cultural values and beliefs, match course goals and objectives with teaching strategies; address barriers 
and obstacles to implementation 

Culturally div-rsr; patients do not fair as well as others in the medical system An increasing literature attests to this 
fact. How do we tram future primary care providers to be more effective at addressing the health care needs of 
underserved communities? This cross-cultural workshop focuses on the issues and skills needed for optimal patient 
encounters. Included in this interactive session is a working definition of diverse which is; "anyone who is not you". 
This definition highlights the fact that enhanced cross-cultural interactions require an awareness in both the clinicians 
culture and the patients. This workshop describes a twelve hour seminar consisting of three sessions, each lasting four 
hours.The optimal group size is twenty participants or less The curriculum is based on adult learner principles and is 
highly interactive and experiential. Pre-session materials are used as a needs assessment and basis of determining 
relevance to the particular audience Pre-session material is also used in developing the tailored role plays. Learners 
are encouraged to cievelop an approach to understanding and interacting effectively with culturally diverse groups. 
Video analysis of films created by the developer as well as commercially available videos are used. These enable the 
participants to enhance their skills of changing the cultural context so as to understand the communication. In addition 
to a skills component this session will provide educators in cultural diversity an opportunity to discuss curricular 
development and irr.plementation relevant to their own institutions. 

Problems Encountered: 

Logistic and resource allocation issues are the main problem in a small group seminar format, especially with large 
class sizes and a scarcity of trained facilitators The seminar format will be contrasted with an ongoing longitudinal, 
integrated curriculum which uses didactics and learning modules from the original seminar. This enhanced awareness 
course is a starting point for increasing knowledge and skills with culturally diverse patients 

Results: 

To date, 227 learners have been trained. These trainees included pre-clinical, clinical students, residents in family 
medicine and psychiatry, mental health professionals (psychologists, social workers, graduate students) and faculty 
The majonty of learners reported increased awareness to difference as a result of the cumculum Voluntary audience 
demonstrated less resistance to the material in contrast to mandatory participants. The ethnic composition played an 
important role in the groups with heterogeneous more able to "test hypothesis" of diverse people than homogeneous 
groups. Groups with pre-existing relationships had special issues which will be addressed. 



Address submissions to: Elena Rios, M.D., M.S.P.H. Telephone: (202) 690-5884 

Office of Women's Health, OASH FAX: (202)690-7172 76 

200 Independence Ave., N.W., Room 730-B 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMlSSiON FORM 
Abstract Tirle- f^-ultural Comnentency: Aoplications for Public Health Practice 
Presenter; Sharyne Shiu-Thornton Title: Instructor 



Affiliation: Dept. of Health Services Telephone: (20^ 616-2940 p^X; (20^ 54^-3^64 

(Medical School/Residency Program) 

Address: University of Washington, 1959 ME Pacific St., Box 357660, Seattle, WA 98195- 7660 

City Zip Code 

Completing the Abstract Submission Form 

■ All tex: should be ryped wthin the penmete's of the box shown. Fonts no smaller than 10 points should be used 
Organize the text of the abstract as follows: II) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4.) results. 



(1) Objectives of the curriculum; 1) to define cultural competency and its 
application to clinical practice, 2) to provide a cultural competency framework within 
which medical and public health education can be critically reviewed, 3) to provide a 
cultural and socio-historical context for understanding the health status and needs of 
both ethnic minority communities and immigrant-refugee populations, and 4) to provide 
practical skills for working with diverse populations in a culturally competent manner. 

(2) Curriculum description: This 5 credit course will specifically and 
comprehensively explore ethnic minority health and cultural diversity, applying cultural 
competency principles into the core competencies of public health practice. This 
course is designed for graduate students and is intended as an in-depth course. It will 
convene once a week for six hours, allowing for a learning experience that will 
integrate formal didactics, experiential learning (including site visits), and group 
process. 

•{Sy Problems (challenges) encountered: Course scheduling is the significant 
challenge due to the extended course format. However, the extended format allows 
for student learning to intellectually stretch beyond a "traditional" didactic approach to 
a larger integrated "lived experience" that incorporates history, religion (spirituality), art 
and other creative expressions that potentially stand as metaphors for human 
experiences of health, illness and suffering. 

(4) Results: Student evaluations overwhelmingly positive (evaluations available for 
review). Seminar included 10 graduate students (MPH, MHA and MSW). Class size 
limited to 16 to allow for off-site visits and field trips. 



V.Mrey. submissions to: Elena Rios. M.O., M.S. PH. Telephone: (202) 690-5884. 

Office on Women's Health, OASH FAX; (202) 690-7172 

200 Independence Ave., N.W., Room 730-8 
Washington, D C 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JULY 21, 1995 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION T 

ABSTRACT SUBMISSION FORM 

Ai^,,. ..^^ y I The Multi cultural Curriculum Project-1 994-1 995 

Children's Hospital Oakland 
Dra~=r>i-Tr- .. i • rr, 1 »/, T~> K/i T^ TTTitlc: Dlr ector, Multicultural 

Pre.-.enre2r. [ V|o] am o T'p■r■^^a^r^n -^ — M.D. / — M-5-P-vHV ' ' 

Affairs 

Affili?>Tion: ^^^^^^^^'^ Hospital Oa k-^^gj^one: (5^)0 ^28 3 33 1 '"A^- i^^LJ} 4-7R-?fi^:Q 

(Medical School/Residency Program) 

Address: 747 52nd Street Oakland 94609 

City Zip Code 

Completing the Abstract Submission Form 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 

■ Urganize tne text vl u'.r abstract ac fcl.'c--: C^ -Ab.prtivns of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4.) results. ^^=,=^=^^— — — ^==^==== 



The City of Oakland reflects trends of increasing racial, ethnic and cultural diversity to be realized in our 
country over the next decades. The Multicultural Curriculum Project at Children's Hospital Oakland was 
conceptuali2:ed as an innovative educational program to teach resident physicians, hospital -based and community 
physicians, and other Hospital staff the many cultural, racial, linguistic and ethnic dimensions of providing effective 
and respectful health care to children and families. The Project involves not simply a descriptive presentation of 
other cultures, but the critical evaluation of the sociopolitical and historical context in which both practitioners and 
family interact, for better or for worse, in the development of therapeutic alliance. We use the existing teaching 
format of the residency program, with community advocates, parents, and faculty members of color from local and 
national institutions making up the core teaching staff. 

From August 1994 through June 1995, over 30 separate sessions were presented, instructing over 1800 
attendees. Most of the sessions were presented in the context of "modules" sets of at least 4 lectures spanning 4 to 
6 weeks and highlighting one racial or cultural group. The content of each module was determined by a 
multidisciplinary working group, composed of Project staff, physician and non-physician Hospital employees and 
commimity members, ethnically or otherwise representative of the group being highlighted. 

As a model program a variety of quantitative and qualitative evaluation techniques were used to assess both 
the content and the process of the Project's pilot phase. Attendance data and participants' post-session evaluation 
forms were collected for each session. We interpreted the persistence of the unprecedented, overwhelming 
. attendance at Project activities as indirect evidence of the applicability and appropriateness of the presented material. 
In fact, of those returning post-session surveys, over 90% specifically felt that the content of the presentations was 
applicable to their work with the Hospital's patients and families. Participants were also satisfied with the quality 
of the presentations. On a scale of 1 to 4 (l=excellent; 2=good; 3 = fair; 4=poor), 72% rated the sessions as 
Excellent, and 92% rated the sessions as Excellent or Good. Finally, though originally focused on the jjediatric 
residents, we came to view the integration of other Hospital employees as critical to the success of this education 
effort, as participants came to recognize and utilize one another as ongoing, internal resources for approaching 
issues of inclusion. 

The problems encountered during this pilot phase included the challenge of presenting complex topics in 
such time-limited forums to a variety of developmental levels among participants, including people's incompletely 
met need for more discussion with one another; the variability of speakers; the need for more focus on distinctly 
defined interactive skills; and underfiinding of the pilot phase at a level to support adequate Project staff. 

Our summary of the pilot stage includes the development of consensus among the housestaff, faculty and 
staff, the assessment of educational need, the evaluation of curriculum content and the group process in its 
development, and preliminary results of the impact on the residents, other practitioners and Hospital staff. The 
Project's potential responds fully to calls for revision in medical education that incorporate multicultural, 
multidisciplinary, community-based and more humanistic components into provider training. 



Address submissions to: Elena R.os, M.D., MS P H. Telephone: (202) 690-5884 

Office on Women's Moaith, CASH FAX: (202) 690-7172 

200 Incependence Ave., N.W., R<^om 730-B 
Washington, D.C. 2G701 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 



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Abstract Title: A 3rd and Ath Year ?r ^-^?^Y ^■'^ r^ Currlci-lum at Ch^nl^P R, Drew Univers i ty 
I A Belinda Towns. M.D. , M.P.H. Chair, Primary Care Curriculum Committee 

jpresenter: Levis A. Hamilton Jr.. M.D. Title: Jean._Post&r aduate Medical E^ycation 

ffiUation: S^^iSl^ f.^^.^P^.Vg^Xr^^^y Telephone: {?l1 ^^62^843 FAX: (>] ^) ■>6V ^9 . 18 

(Medical School/Residency Program) 



Address: 1621 East 1 ?Orh Str ePt. MP19A. Los A^eeles, CA 900^9-30^2 



City Zip Code 



:ornpieting the Abstract Submission Form 

AM rexr should be typed w.thin the perimet-rs of the box shown. Fonts no smaller than 10 po.nts should be used 
Organize the text of the abstract as follows: (1) objectives of the curriculum; 12) cumculum descnption; 
<3) problems encountered; and i^i results. • 



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CURRICULUM C«JECnVES: The intent of the Primary Care Program is (1) to encourage students to become 
primary care pliyT:icians, (2) to teach them how to assess and manage acute and chronic modica] problems 
frequently encountered in the Los Angeles inner-cit>', and (3) to enhance their understanding of; 

• The place of ^mary care in the American Healtli care system, and the importance oi the ambulatory care 
clinic setting for the pro^^sion of primary care 

• The multi^cultural commumt) served by Martin Luther King Hospital and Charles R-Drew Universit>': its 
composition, charactenstics, and health care needs 

• The need to ptuvxdc cost cfifcctrv e continuous as v>vU as episodic health care and to provide anticipatory health 
care using education, risk reduction and health enhancement strategies. 

• The importance of ( 1 ) knowing the cultural backgrounds of patients, (2) demonstrating sensitivity in working 
with a multi -cultural patient population, and (3) developing diagnostic and treatment plans in partnership ^ith 
patients and their families. 

• The role of the Primary Care physician as researcher, health-care team member, community leader and 
legislative advocate. 

CURRICULUM DESCRIPTION: Third year clerkship activities consLst of a weekly conference series and a 10 
month half-day-r:-weelc experience in an MLK ambulatoiy clinic. The conferences focus on societal issues 
i.iKJuding.inteF :cUtural comrnimication, epidemiology, health services, health poiic>% and social concerns. Students 
participate in discussioi^s of such subjects as AIDs in the African American commumty, the epidemiology- of 
Latino health, alternative fonns of health care, to name a few. In the foiuth yeaL.,£rimaiyCare is a sixteen week 
{Kogram. Stu^knts are placed| with community health care pro\ider$ where ibey continue to build on their clinical 
experiences withaimilii-oiltuial potiect population, and they participate in aprtmary care rese arch pitgect. 
PROBLEMS ENCOUNTERED; Among the difficulties experienced in the first two years of this program were 
( I) stimulating the students v|ho had varied clinical interests to focus on the "softer'^ saences; the psychosocial 
needs of the patients, intercnltural communication, etc , (2) comening faculty from five departments anc obtaining 
their support, (3) coordinating community providers and consultants. 

RESULTS; Results have been mixed, ranging from one extreme to another, with some students responding on 
program ev-aluiticn questionnaires that this rotation was the most valuable in their entire medical school 
experience, and other students indicating that they hated it The majority of students, however, have responded 
favorably, and many seem to be selecting a "primaty care" f^ogram for their residencies 



^,Mr«.. submissions to: E>ena RioS. M.D.. M.S P H. Telephone: (202» 690-5884 

Off.ce on Women's Health. OASH FAX: (202) 690-/1 // 

200 Independence Ave., N.W.. Room 730-8 
Washington, D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JULY 21, 1995 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: Cultural Diversity and Preventative Health Care f nr Wnrnpn During Prpgnanry j 

Presenter: Dvanne D. Affnn-^n. Pbn, fa an Title: Dean and Professor , 

Affiliation: Emory University - Nursing Telephone: f404) 727- 7976 FAX: (404 727- 4 645 

(Medical School/Residency Program) 

Address: School of Nursing, 531 Asbury Circle Atlanta. GA 30322 ' 

City Zip Code 

Completing the Abstract Submission Form j 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller than 10 points should be used. 1 

■ Organize the text of the abstract as follov/s: (1) objectives of the curnculum; (2) curriculum description; 

[Z'l piCCiiciiiS ci'icouniered; ana i4) resuits. ^ 



Objectives: 

1. Describe the use of innovative conceptual models for delivering culturally competent 
prenatal and postpartum health care services. 

2. Delineate alternative program mechanisms that incorporate deference for cultural beliefs 
and diverse w/ays of "knowing". 

3. Examine the potential for community partnerships and social marketing strategies for 
improving access and retention into preventative health care services for pregnant women. 

Curriculum Description: 

During the last decade, much has been written on the importance of prenatal care in 
preventing low birthweight and neonatal morbidity in the United States. Little progress has 
been made in improving earlier access and long-term retention into prenatal care for those 
who need it most: poorer women (often from minority and ethnically diverse groups) in both 
urban or rural areas who tend to have a higher incidence of perinatal and neonatal morbidity. 
A research-demonstration project in near completion on the rural island of Hawaii was 
successful 4n providing first trimester and consistent participation in prenatal care. Use of the 
cognitive adaptation model including search for meaning, gaining a sense of mastery, and 
self-esteem enhancement will be described in terms of use in program development. 
Program mechanisms such as the Neighborhood Women's Health Watch and supportive 
ethnic healing systems for the Hawaiian, Filipino, and Japanese women who participated in 
the program will also be described. Finally, how partnerships with both women and men 
from a local community can be mobilized to participate in the planning and evaluation of a 
pregnancy health care program will be presented. 



Addrerr. submissions to; Eiena R;os, N1.D., M.S PH. Telephone: (202) 690-588^ 

Ofnce on Women's Health. OASH FAX: (202) 690-7172 

200 Independence Ave., N.W., Room 73C-B 
Washington D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 



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Yamila Azize Vargas. Ph.D. 

Box 10000 Suite 292 

Cayey, PR 00737 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL 
EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract tittle: Latina Issues and Perspectives for a Gender 
Balanced Curricula in Medical Education 

Presenters: Yamila Azize, Ph.D.; Coordinator Women, Health and 
Science Research; 
Luis A. Aviles, MS, MPH, 

Afiliation: Y. Azize 

Women's Studies Program 

University of Puerto Rico, Cayey Campus 

Telephone & Fax: 809-738-4218 

L. Aviles 

John Hopkins University, 
School of Public Health 
Telephone : 410-752-4317 

Mailing address: Box 10000 Suite 292, Cayey, P.R. 00737 

1 . Introduction : 

The idea of cultural competence in medical education 
became more popular when the clinical practice of physicians 
started to face the challenges of an increasing cultural, 
racial and ethnically diverse population in many cities of the 
United States. For the most part, the concept of cultural 
competence has ignored the dialectical relationship between 
biology and culture as it applies to women's health. Cultural 
competence in medical education can not be adequately deal 
with women's health issues if the feminist scholarship on 
. women-cLnd-health-i'S ignored. 

The experience of teaching the course Women and Health in 
the Medical Science Campus of the University of Puerto Rico 
will be used as a case study that will offered valuable 
information on broader issues of cultural competence on 
women's health in medical education. 

2. Objectives of the Curriculum: 

The main goal of the course was to provide physicians, 
nurses and other health professionals with a feminist 
perspective on women and health in order to analyze health 
policy issues at the levels of clinical practice and social 
policy. 

3. Curriculum description: 

The course begins with a general introduction to women's 
history of social struggles and their participation in the 
nascent health professions at the turn of the century. Then 
the course analyze women in science (both as an object of 
science and as scientists) in order to provide a theoretical 
perspective to deal with specific health issues such as: 
reproductive and social health and rights, the medical ization 
of women's health, reproductive technologies, AIDS, 
occupational health and elderly women. 



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4. Problems encountered: 

The main problem encountered was the resistance of health , 
professionals to acknowledge the gender biases in scientific 
research, clinical practice and social policy. 

5. Results: 

In spite of the resistance found, most of the students f 
were interested in the new prespectives and materials 1 
presented. Some reserch projects were able to document 
particual biases against women. For instance, one project f- 
studied the medical forms that government employees have to | 
complete finding that there was a question asking how many 
abortions a woman had and if her period was painful. Other 
project focused on policy issues for the elderly women. r 



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CULTURAL COMPETENCE AND V/OMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 
Abstract Title: Domestiic Violence Curriculum 



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Flora Bryant, Ph.D. Adjunct Professor, School of Social Work 

Presenter: Michelle Grant, M.D., FACEP Title: Department Chair, Emergency Medicine 

Howard University 
Affiiiation: Deot. of Emergency Medicin eTelephone: (20;) flfiS -H 71 FAX: (20;^ RfiS-44Qp 

(Medical School/Residency Program) 



Address: 2041 Georgia Ave., N.W. Washington, D.C. 20060 

City Zip Code 

Completing the Abstract Submission Form 
■ All text should be typed within the perimeters of the box shown. Fonts no smaller than- 10 points should be used. 

Organize the text of the abstract as follows: (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. _^ _^ 

Goals : 1. Education of Health Professional Staff (HPS) on 

1 recognition, screening, treatment, and prevention of Domestic 
I Violence (DV). 2. Enlighten Howard University Hospital (HUH) 
! patient community about DV recognition, treatment, empowerment 

skills and resources for prevention. 3. Enhance awareness of HPS 
and HUH communities regarding the impact of myths, misinformation, 
cultural and gender bias attitudes impacting and sustaining DV. 
Objectives : 1. Delineate DV definitions, etiologies, at-risk 
groups, and effective protocols, policies, procedures, and 
practices in biological, psychosocial, political, and gender 
sensitive context. 2. Increase HPS awareness regarding DV as 
public health, moral, and criminal justice issues. 3. HPS should 
recognize the impact of disempowerment , socialization of females, 
myths, and cultural bias of their own attitudes, thoughts, and 
actions on DV. 

4. Discuss ethical principles of DV which include beneficence, 
justice, and patient's rights. 5. Investigate issues: 
- -sexual/emotion^l/psychological trauma in individual and family 
development and treatment processes. 6. Operationalize cultural 
competence into the spectrum of DV health care. Currinnlmn 
Description - 3 Components: Pre- and post-test evaluation tools 
will be a video developed with questions generated from it. Short 
answers will be expected. Key issues in DV will be covered in 
small group sessions, viewing videotapes, and discussions based on 
articles compiled in a teaching manual. Education will be aimed at 
HPS and the community. Interviewing skills will be a component of 
HPS education. Problems Anticipated/Possible Barriers : 1. Fund- 
ing for implementation, ongoing education, and ongoing evaluation. 
2. Underreporting of domestic violence by health professionals and 
the law enforcement community. 3. Changing attitudes of 
professionals so that priority time is invested in screening, 
recognition, prevention, and treatment activities. 



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Arirfrfics submissions to: Elena Rios. M.O.. M.S.P.H. Telephone: (2021 690-5884 

Office on Women's Health, CASH FAX: (202)690-7172 

200 Independence Ave.. N.W., Room 730-B 
VVasf'.lngtcn, O.r. 20201 



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CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATIQ 

ABSTRACT SUBMISSION FORM 

Abstract Title: "CORONARY ARTERY DISEASE (CAD) AND GENDER: PREVENTION, DIAGNOSIS AND ' 

MANAGEMENT" - A COURSE FOR RESIDENTS AND SENIOR MEDICAL STUDENTS. ' 

Presenter: P R- PAMELA CHARNEY ji^lg. DIRECTOR, GENERAL INTERNAL MEDlCINf 

■ " ■ WUKhN'S HLAJ.TH TRACK "^ 



ALBERT EINSTEIN COLLEGE OF 



Affiliation; MEDICINE 



Telephone: (719 918-746^ 



(Medical School/Residency Program) 

JACC3I MEDICAL CENTER PELHAM PKWY. & EASTCHESTER RD. 



FAX: ri8)918-77m 

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BRONX. N.Y. 10461 



Address: _^ 

City Zip Code 

Comploting the Abstract Submission Form 

■ All text shotrio be typed within the perimeters of the box shown. Fonts no smaller than t O points should be used. 

■ OrQaniza the text of the abstract as follows: (1> objectives of the curriculum; {2} cumcuJufn description; 
(3) probJems encountered; and (4) results. 



"Coronary Artery Disease- (-CAD) and Gender: Prevention, Diagnosis and Managomenf 
a course Jor residents and senior medical students. Drs. P. Charney, S. Dresdner, 
and L. Lemberg. 

CURRICULUri OBJECTIVES: 

1) Review major clinical issues in the prevention, diagnosis and 
nvanageiaent of CAD with a focue on patient diversity. 

2) Improve skills in critically assessing the medical literature. 

CURRICULUM DESCRIPTION : 

Over four weeks, about 30 hours were spent in lectureff, group discussion and 
presentations by participants. Topics included: principles of preventive health; 
smoking cessation: gender issues and clinical approach; hyper tens ion. as a risk 
factor for CAD; lipids, gender and CAD; diagnostic testing for CAD; clinical 
approach tc chest pain (included- panic attacks); catherization and bypass: bias 
in clinical medicine (focusing on race and gender); pxiblic perceptions of gender 
and CAD; and presentations by reading groups. A bibliography was developed by the 
core faculty (Drs. Pam Charney and Paul Marantz). Exploration of race and class 
issues was encouraged. 

The residents (PGY 1-3 Primary Care I. M.) and fourth year medical student were 
-organised into small xeading groups which reviewed and presented a topic of their 
choice. Written evaluations were completed after each session and at the end of 
the month. 

PROBLEMS EWCOUWTgRED t 

Reading groups had difficulty finding time to meet and faculty felt 
underutilized. Participants noted there were too many required readings and more 
extensive review of basic concepts waa needed. Current limits in knowledge of 
the impact of gender, socioeconomic class and race were frustrating. 

RESULTS I 

The eight participants noted improvement in many specific content areas and their 

ability to critically review the medical literature. Overall the course was rated 

3.2 on a 4 point Likert scale (4=excellent, l=poor). Individual presentations 

were rated fo;^ "topic importance" from 3.4 to 4.0 and "presentation effectiveness" 

from 3.1 to 3.9. Faculty were impressed with the quality of presentations by 

participants. 



Address submissionr to: 



Elena Rios. M.O.. M.S.P.H. 

Office on Women's Health, OASH 

200 Independence Ave., N.W.. Room 730-B 

Washington. D.C. 20201 



Telephone: 
FAX; 



(202) 690-5884 
(202) 690-7172 



DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 



84 



tot« 



■/ CULTURAL COMPCTCNCE ANO WOMEN? HEALTH CURKfCULA IN MEofoAL hUU.,M» 

I ABSTRACT SUBMtS&ON FORM 

Abstract TitJo: Cultural Competence and Women's Health Curriculum in Medical Education 

[reaemef; Molly S. Chatterjee, M.D. Title: . Professor and Director, Ma ternal Fetal Medicine 



I 



miMXion: Meharry Medical College Teltphcrw: ( 6}5 327-6284 j,^^. ^61^ 327-629 6 

Addre«; ^^^^ ^'^' ^"^^ B^vd. Nashville, Tennessee 37208-3599 

B Chy -' Zip Code 

Womphdng th« Ab«vact Subml»4ion Form 

! JL^ **!Tf^ *^ T**^ '^*'*^'' ^ ••'wncto/* «f iho boic .ho^n, ^oot, no *m4HV trtan TO poifttt should bO UMd 

nS?^ **" *" *^ •***'^ " *^'^*' "^ otiicctivw Of xhs, cgrrtoKum; (2J earrtcuiom SMcripxkHv 
■" »roaUm» f>cq«nuftd: and U» n*idt9. 




Objectives: The proposed curriculum will increase the competency of students and 
residents to deal with patients of diverse cultural backgrounds. They will acquire 
compassion and sensitivity for the minority population 

Curriculum Description: 

1 . Medical schools with a broad diverse faculty should be selected nationwide as 
sites for training. ' 

2. Local physicians, other health care providers and educators of diverse cultural 
and geographical backgrounds will be invited to become resources. Religious 
and cultural beliefs should be taken into consideration by health care providers, 
e.g. a) Muslim religion: how women feel about male physicians and how 
sensitive they are to expose their body, etc., b) Female genital mutilation in 
Somalia, c) Taboo for cesarean section in the sub-Saharan continent of Africa. 

3. Electives in different geographical areas may bo encouraged with funding from 
the Biomedical Research Foundation with cultural exchange programs. 

4. Students who have managed 10 patients during their clinical rotation will be 
- -rewarded with extra credits upon evaluation. 

Problems Encountered: 

Lack of funding and motivation of students and residents. 

^ Results: 

11 

jLJ A pilot study for a one year period may be Implemented and could bo evaluated. 



] 



r-*na^'. ..Bi" i*j 



Iresi «uhmiMicn« :o; iJf •>• Riot. M.O,. M.S.P.H. 

Onie« on Womwi't HtilK 0A5H 

200 ir\^psfya4i\c* Av«., N.W . n^ocr, 730^ 



T«(«l>h0#ts; 
^AX: 



(2021 6tO-68t4 
1202) 690-7172 



oeAOUNE FOn SUSMISCION; miDAY. 0t^Ne-3C^. -l^9€ 



I 



85 



I CULTURAL COMPSTENCc AND WOMEN'? HEALTH CURRICULA IN MEDICAL EDUCATION 

: . • ABSTRACT SUBMISSION FORM 

Optimizing H^lth Outcomes in Etimically Diverse Women vlth HIV/AIDS: 

.' Abstract Title: ; CcoitlmiiDg Medical Education for Primary Care Physicians 

: Helen L. ^Coons, Pli.D. fend Clinical Assistant Professor 

Pr^senrT- "^^^^^ ^* '^^^^^2* MD jj^jfs; Assis-tant Dean of Generali.sa & the Ccacmun.^j 

I Medical College of P«>rtn5ylvaTi1a & (215)T62-T6i6 (215) 762-8654 

i Affiiistion: Hahnprmnn ynl-yierslty Telephone: ( ) FAX: ( ) 

• ; (Meaicai ScJiOO^'ResjdencY Program) 

Addr • '' ^°^ * t^^ Streets, MS 4^*0, Philadelphia, PA 19102-1192 

! ■ 1 -i ; ■' ^'^V Zip Code 

i Completing the Abstract: iSubmission Form 

[ « All text shjoutd be tvp«d yvitrun tneiperimeters or the box shown. Ponts no smaller than 10 points should be used. 

i • Organize t^e text o~ the abstract as foilows: (1) objectives of the currtcuium: (2) curricuium description; 

' •31 orowierns sncounteredc land 1^5 r^suits. 



id) OBJECTIVE OF 1J|iE;CURRICULUM ! 

A. Increased knowledge lof gender,' ethnic, and class-based differences relevant to xhe care of women with HTV/AIDS. 

B. Increased knowledg- jof a biopsychosocial approach to HIV/AIDS in women which is essential for effecdve evaliiation and 
treatment j ! : ' : 

,C. Increased knowledge pf factors associated with risk for health and mental health problems among women with HTV/AIDS. 
;D. Increased knowledge iaf Strategies to promote optimal health and mental health outcomes with ethnically diverse women with 

HIV/ifJDS I I'i' ■ i 

iE. Role linodel raultidisclpKnary cdllaboration in teachbg and care of women with HIV/AIDS. 
'■ ' \''\: ■■ : 

(2) CURklCULUM DJJSCRIPTION 
A. Cont<int j li'! ' j B. CM£ T^^chi^is Stratggie<? 

• Epiddniology of HTv/AlDS in women in the United States. * Small group format with a multicultural, 

• Biopsychosocial appijoiach to HIV/AIDS in women. multidisciplinary teaching team. Team consists of a 

• Divei!sity among woijien coping with HIV/AIDS (i.e., physician, clinical psychologist social worker, and 
ethnicity, S.E.S., agej religion, education, relationship status, women with HTV. 

! sexual orientation, et(t.)i I -Video analysis of women coping with HTV/AIDS to 

I • Gender and cultiiral differences; in communication style: illustrate the social, cultural, and relational context of 

Impact on the physican7plaiient relationship. women's lives. 

; • Within and across ethnic and age group diversity. • Clinical vignettes of ethnically diverse women with 

• Risk factc^s for deprissi!on andisubstance abuse in women with HTV/AIDS. 
HIV/KlDS. ' j : ! • Bibliography on biomedical, socioculturai, and 

• PromSbting optimaThialth outcomes in ethnically diverse psychosocial aspects of HTV/AIDS in women, 
women wjth KFV/Albsi 

j ! I 1 ; ; i C. Evaluation Strategy 

, . jj i 'Pre- and post-test of knowledge of HTV/AIDS in women. 

(3) PROBLEMS ENCOUNTERED 
Overview approach does not allow for in-depth discussion of complex socioculturai issues. 
Limited baseline knovvledge of within and across ethnic group differences among women. 
Limited appreciation for; the social and cultural context of women livfes. 
Working from a biopsycJiosocial perspective in the climcal encounter. 
Limited experience \yorfcing from a multidisciplinary perspective. 



II 



(4) RESULTS 



Feedback indicated increased knowledge of: 1) epidemiology of HTV/AIDS in women; 2) gender, ethnic and class issues 
relevant to the cvaluatioii and treatment of women with HIV/AJDS; 3) strategies to provide gender and culture specific care; 



j , 4) muJt:discrp'im.ry dare., 



•^dr?. ■^•-■; inomiss.ons to: Eiena Hies. M.O.. M.S. P.M. releohone: (202) 550-588- 

0<f"!c« on Wooen'a Seakh. OA5H PAX: (202)690-7172 

i 20C indeoendsnce Ave., M.W.. Room 730-3 

Washington. D.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1 995 

86 



I 
I 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 



^bstracT Tiile- Reframing Women's Health; An Intensive Mult idisciol marv Insti tur^ 
Zylp>iia Ford, M.P.H. Project Coordinator 

Presenter: Alice Dan, Ph>D- Title: Director «^_ 

niv. of Illinois at Chicago 

f^t.^n^n^ ^gn^^PJ^^g?^ °" ^^^" Telephone: f^i^^^l^ 10?4 FAX: Ml 4n-74?l 

(MeOical Schoo</ReskJencY Program) 



^u . 1640 W. Roosevelt Road (M/C 980) Chicago IL 60608-6902 



City Zip Code 

Iompieting the Abstract Submission Form 
All text should be tvp«d wtthio the perimeters of th* box shown. Fonts no smaller than 10 points should be used 
■ Organji« th« t«xt of the abstract aa follows: (t) objectTves of the cumculum; (2) cumcufum descnption; 

{D prob*«m3 ancountared: and (41 results. 



Examining the impact of the political, cultural, economic, social, psychosocial, and spiritual 
aspects of wom«i's health is essential. These aspects must be integrated into the development and 
design of all women's health programs. A ten-day multicutural and multidisciplinary institute 
allowed women's health experts to work together to forge a new, comprehensive, and inclusive 
vision of the future of women's health. 

The curriculum was designed to foster multidisciplinary cross-fertilization in various key aspects 
of women's health: education, practice, research, and policy. The curriculum objectives were to: 
Reconnect the women's movement by gathering resources and exploring alternatives for women's 
health practice, education, and research; outline the guiding concepts underlying the principles of 
women' health; stimulate and foster multidisciplinary collaboration in women's health; enable 
participants, according to the needs of their situation and target population, to develop curricula 
or programs; include women of all communities and their self-identified health concerns in the 
development of all women's health programs; set directions for policy development in women's 
health; explore options and mechanisms for promotion of excellence in women's health. 

A two-<iay Pre-Institute was held the previous weekend to prepare women in traditionally 
marginalized communities for participation in the larger Institute. Participants of the Prc-Institute 
included women of color, lesbians, disabled women, and poor women. 

Participants dd)ated over the tone of the Institute: some felt it was too medically-oriented; others 
felt it was too "anti-medicine." Accessibility for women with disabilities also created unanticipated 
difficulties. Women from traditionally marginalized communities participated less than planners 
anticipated, despite the use of various inclusive strategies. 

A number of innovative endeavors have sprung from the Institute, including two inter-institutional 
women's health curriculum groups, one undergraduate and the other post-graduate. 
Multidisciplinary and cross-institution collaborations in women's health are on the rise as a result 
of this remarkable institute. 



J 



W^K -(.ubmissions to: Elena Rios. M.D.. M.S.P H. Talaphona: (202) 690-5884 

Office on Women 3 Heattn. OASH FAX: (202) 690-7172 

llMIHMIII!llyi.llt.0,.J!!y 

WasPingron, D.C 20201 



CULTURAL COMPETfZNCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT iJUfaMiSSlON FORM j 

/ Oitrjrt Title' jJii.I.^uj:al, Xsg.ues ...in Comnunicat ion ..bout Breast and Cervical Cancer Screening 

Presanrer: Roberta Goldman, Ph.D. r;tr<».M a ■ ^ ^ ^u i • ,^-, • • -i * • 

I iiie. Medical Anthropologist; Clinical Assistant 

Af*. I. -.».,.«. Professor of Fam . >;ed 

Affiluicion. .p,p,^^,-n '-nivprsatv felephona: (40j_ 729.-2924 FAX; 401)729 . 2923 

(Mediral School/Residency Proyram) ' — — ~ — ^ " , 

Addross: Department of Family Medicine lllBrewster Street, Pawtucket, RI 02860 

Completing the Abstract Submission Form '^^ ^'^ ^^^^ 

: Or,!"^' the 'L't iZt T:: "" "rr'^'^ °' '^^ ""^^ •'°""- ^-^ - -«"- ^^- ^ O Po-nts ahould be used, 
urjan.zo (he text of the abstract as ioV.^^i. (i) obiect.ves of the cumcu/um; (2) curnculurn descnution- 
(3) problems encounterod: and (41 results. "'cu.um aescnptJon. 1 



Ohicctives : A curriculum for medical .studcnLs i.s being developed at Brown Univer.sity School of 
Medicine to enhance communication and coun.seling skills around breast and cervical cancer screening. 
Information and skills for culturally responsive communication are integrated throughout the eight-module, 
c omp rehensive cuiTiculum. Two modules focus specifically on cultural competence: an introduction'to the 
cultural influences in the doctor/patient relationship; and a module on the range of .sociocultural and 
sociostmctural issues pertinent to breast and cervical cancer screening. 

The purposes of the culturally focused modules are to enhance students' awareness of the content of 
their own cultural dispositions; to heighten understanding of the impact these dispositions have on their 
communication wiili women about cancer screening; to enhance understanding of the cultural and 
sociostmctural factors that impact communication, affect access to health care, and create bai^riers to breast and 
cervical cancer screening; and, to improve students' skills in communicating with women about cancer 
screening and eliciting their perspectives. 

Curnculurn de.scription : The cuniculum incoiporates a vai^iety of teaching methods, including didactic 
lecture, case discussion, small-group exercise, and role play. In year 2 of the project, videotaped vignettes for 
triggering discussion will be produced. The cultural modules cover the knowledge, attitudes and 
communication skills students need for a culturally responsive approach to counseling and screening, 
including: cultural self-awareness; the culture of western medicine; patients' health beliefs and explanatory 
models; cultural values of modesty, privacy, and personal disclosure; culture, gender, age, and class 
influences on communication; the use of power and authority in the clinical encounter; ethnic differences in 
breast and^ervical cancer screening, incidence, and survival rates; ethnic differences in attitudes about cancer, 
perceived risks, preventive care, and screening procedures; cultural and sociostructural baniers to screening; 
and skills for practical application. 

Problems encountered : While a variety of depaitments within the medical school are enthusiastic about 
including these modules in tlieir program, the subject area encompasses a broad range of issues that must be 
taught in relatively short time periods. The concepts of cultural responsiveness comprise a new approach to 
teaching about breast and cervical cancer screening, and some instructors may feel uncomfortable teaching the 
material without faculty development assistance. I 

Results : In preparation for writing the cuniculum. focus groups of medical students and residents, 
and interviews with faculty and clinicians were conducted. Findings from the research show that the teaching 
of communication aspects of breast and cervical cancer screening is generally insufficient, and cultural issues 
are often ignored. Pilot testing of the cultural components of the curriculum will begin in August and_ 
Septem ber 1995 in the Brown University Family Medicine Clerkship andMedical Intei'viewing course. One 

Lmeans~oF evaluation will be student participation in an Objective Structured Clinical Exam (OSCE) at the end 
_QLt^i:^;;faaiI^;J^ledi£injLQ^'kshir) rotation. 



\,i:ir.^<-' siibn^jssions to: Glena Rios, M.D.. M.S. PH. Telephone- 

Office on Women's Health. CASH PAX: 

200 independence Ave., N.W., Room 730-8 
Wasfiirigton, OC. 70201 



(2021 690-5884 
(202) 690-7172 



DEADLINE FOR SUBMISSION: FRIDAY. JUNfj e/lSSS 

88 



I 
I 



CULTURAL COMPETflNCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT isUBMlSSlON FORM 

, ., _. Teachine the Cultural Dimension of Maternal and Child Health in a Family 

Medicine ResiHency'~^i^ogi^an ■ ■ 

rfisanter: Rober ta Gold man, Ph.D. p.^,g_. vtedical Anthropologist; Cli nical Assistant 

/-^1 7To_9n9A Professor or tamT Med 

ff.l.onon: Brown University relephone: L_J. - ^^ FAX: <-i:) 7?.-:-:923 

(Medical School/Residency Proyram) 

driross: Dept. of Family Medicine 111 Brev;ster St., Pawtucket, RI 02860 



I 
f 

i 

? , , ^ ^'^y Zip Code 

Completing the Abstract Submission Form 

■All ten should be typrd withm tho pcm^t^rs of the box aho^n. Fonts no smaller than 10 points should be used 
■ Or.jan.ze (he t«xt of the abstract as follows: (1) objectives of the curnculum; (2) curnculufTTdcscriution- 
^<3) problems encoimterad; and (4) results. 

r= = — =_= — =_= ^ __ 



Background : In the increasingly multi-culturaJ environment of American health care, resident physicians are frequently 
called upon to address patient care issues that they have not been specifically prepared for. Since introduction of the biopsychosocial 
model in tJie late 1970s, it has become more common lo address patients' psychosocial issues during hospital teaching rounds, 

peciaily in primary care residencies. In recent years, culture has been added to tlie mix of nonmedical variables that residents must 
.-knowledge. It can be difficult, however, for residents to conceptualize how Uiese medical and nonmedical issues interact, how to 
Tniei^rate thinking about social, cultural, and psychological aspects of patients' lives into the development of a patient care plan, and 
^^jow^to avoid becoming overwhelmed by the complexity these issues present. Culture is an especially confounding factor, as cultural 
lloecialists, unlike social workers or psychologists, are rarely available for consultation. In addition, residents' own cultural 
jl/ispositions impact the patient encounter in ways in which they are often unaware. 

For the past 4 years, a medical anthropologist has implemented a curriculum on cultural issues in health care in the Brown 
■IJniversity Department of Family Medicine residency program. One significant aspect of the curriculum concerns women's health. 
I: is targeted to residents during their Maternal and Child Healtli (MCH) rotations in a Brown-affiliated community hospital that 
I serves two culturally diverse communities comprising immigrants from Latin America. Ponugal and West Africa. The MCH 
Irotation was chosen for a number of reasons: In tlie perinatal period, a patient's cultural dispositions have great impact on her 
■lecisions and behaviors. Social and cultural issues assume heightened importance widi the involvement of the patient, her 
lleveloping baby, family, suppon system, and health care providers. After delivery, there is some urgency to health providers' need 
to clarify a patient's history and current situation prior to her leaving the hospital with tlie baby. And on a purely practical level, 
-^•nding sufficient time in a comprehensive family medicine curriculum for teaching "new" subject areas is problematic; the MCH 
I btation provides considerable exposure each year to both first and second year residents. 

^ Ohiectives : The objectives of the curriculum during tlie MCH rotation are to increase residents' awareness of social and 

cultural issues-importtnt to-patient care; increase undersLinding of how residents' own cultural dispositions impact their interactions 
'ith patienLs; and enhance residents' skills in culturally responsive communication and care. 

Ciirriculmn description : The medical anthropologist teaches during morning teaching rounds on the obstetrics floor, on an 
hidividual basis in case discussions with residents, and during consultation witli residents, patients, and the patients' family and 

Uacial supporLs. Cultural issues are integrated into the nonnal routine of teaching rounds and morning care, and are raised by the 
nthropologist as well as faculty and fellows, and by residents themselves. During teaching rounds case-based discussions are 
roadened to address cultural issues of general impact on patient care. Topical areas include: social conditions, access to health care 
and health and birth practices in patients' countries of origin; immigration, acculturation, and economic survival; patients' 
j ixpectadons and perceptions of physicians and the healUi care system; healtli beliefs, personal care and baby care; dietary practices; 

Jreastfeeding; role of family members; household patterns; social support systems; communication styles. 
'-^ Problems encountered : Time constraints and language barriers can lead lo residents' avoidance of, or difficulty in coping 

wiUi. unfamiliar social or cultural issues. 

J Re.sult.s : The overall cultural curriculum has received highly positive evaluation by residents, with particularly favorable 
valuations for exposure to teaching during the MCH rotation. 



•— *— — "~-~— - 



/.'.•' «.ibmissions to: Elena Rios. U.Zi.. M.S.P.H. Telephone: (2021 690-5884 

Office on Women's Heallh. CASH FAX: (202> 690-7172 

200 Indepandence Ave.. N.W.. Room 7 30-8 
Washington, DC. 70201 

DEADLINE FOR SUBMISSION: FRIDAY. '^Wrif^r 1995 89 



CULTURAL COMPETENCE AND :AL EDUCATION 

AB 



-^'C^y^.^ C(:,A' 



Abstract Title: ■lr\r>Q\/a.-V\\/ f, .S 'J'rCLrtoicS -fs/- i-leo./-th C^ re : 

The fro^^'^A<=^ 

Presenter: fAoLr\Q^ fUCL .G 6yyv € Z- i-^J^Pn^ 

Affiliation: rA^t/; pg>s.A Co)rv..^ .o a- : t-^ We,Xt/, -?G.j.ja./<>j :>0 : fOt>/) 7(^1 'Jl\'^'^ ^ 

\ — -"^ ■" -La ' ^ — '-J 

(Medical School/Resiaency Progr 

Address: i 7^ |v. \ If- 1 C. S V i ./ry'.r>. K.'^T ( . -O J 

Zip Code 
Completing the Abstract Submission F 

■ All text should be typed within the perimeters of the box shown. Fonts no smaller tridii iw quints should be used. 

■ Organize the text of the abstract as follows; (1) objectives of the curriculum; (2) curriculum description; 
(3) problems encountered; and (4) results. 



Promotora or lay health worker (LHW) models are effective 
bridges between the traditional health care system and low- 
income populations who have difficulty accessing the system. 
These models have a precedent in Third World countries where 
health care personnel and resources are scarce and have worked 
successfully in the United States since the 1950 's. 

Most promotora models work within the open system of a 
community and address not only many types of health problems, 
but many people, not all of whom can be identified at the 
outset of a project. A promotora works within her clients 
cultural and psycho-social context. She is a member of the 
target community and reaches her clients through non- 
traditional means, i.e., factories, laundromats, outside 
churches, and shopping malls. She is trained in specific and 
general health topics, but cannot give medical advice. The 
promotofci partners with the targeted population to access 
quality health care for low-income clients. 

An effective lay health worker model has a variety of 
important outcomes to be measured at different conceptual and 
organizational levels; for example, changes in behavior of the 
woman being served and the woman's family; changes in the 
overall characteristics of a community, such as adequacy of 
prenatal care or the reduction in certain risk conditions, 
such as exposure to preventaible communicable diseases. 

In most promotora programs, the impact of the program on 
the lay health workers themselves is an important outcome. 
These outcomes might include the LHW' s assumption of community 
leadership and advocacy roles, their transition to 
professional roles, or their return to school for more formal 
education and a better life. 

This creates a spiral effect of personal and community 
empowerment. As the promotora helps others, she helps herself. 



Address submissions to: Elena Rios, M.D . MS PH. Telephone: (202) 690-5884 

Office on Women s Health. OASH FAX: (202) 690-7172 

200 Independence Ave . N.W.. Room 730-8 
Washington, DC 20201 «« 

nc A ni IMC cno CI iPMiccir-iM' VTirfcl^, 4,,^^,,,,^ /, too- 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 



Abstract TKIe: Resident Education in Diversity Awareness in a Managed Care Setting 
Presenter: Lesley R. Levine, MD Title: Ob-Gyn Program Director 

Affiliation: Kaiser Permanente Medical Center phone (510) 596-6361 , fax (510) 596*7456 
280 W. Macarthur Blvd. Oakland, Ca. 9461 1 



Obieetives: (1) To develop within each resident a sense of self in relating to 
their own culture. (2) To increase awareness and educate about other cultures, 
orientations, lifestyles.and disabilities. (3) To help the resident integrate this 
new knowledge and experience with their own concept of self, specifically to be 
able to offer medical services to a wide variety of women in a sensitive manner. 
All of these objectives are to be met within the structure of a managed care 
environment, ie: Ob-Gyn residents are taught to assume global responsibility for 
patiertts as their primary care provider. 

Curriculum DeacriPtion: A variety of curricular activities are used to meet the 
above objectives. Retreat days are used to understand and share individual 
identities in a diverse resident population. Also on these days the residents are 
assigned exercises to develop team work skills and to learn how different 
people may approach the same situation differently. Other workshops directly 
deal with our differences and how differences can lead to opportunities. Several 
times during the year community health leaders from diverse backgrounds are 
asked to address the residents. They discuss their concerns with health care 
specific to their communities and with regard to Kaiser Permanente as a 
providing system. Lastly, and most importantly cultural aspects of health are 
brought up and discussed contiunually with respect to patient's diagnosis and 
treatment. Integrating the information residents gain in workshops with 
everyday experienoe'is perhaps the most important part of the curriculum. 

Problems Encountered; The most pervasive problem has been to increase 



awareness among the attending staff so that they understand the reasons 
behind the workshops, and support and feel comfortable with bringing up 
cultural issues during case discussions. Also the quality of workshops devoted 
to developing cultural awareness varies a great deal. 

Reaulta: The results of this long-term, integrated curriculum has been to 



increase awareness of and comfort with cultural aspects of health care. This 
includes Issues of race, ethnicity, gender, sexual orientation, and disabilities. 



91 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION (; 

ABSTRACT SUBMISSION FORM 

I 
I 

Abstract Title: Faculty Preparation for Women '.q He.a lrh riiirri ml ;^ DpvpI npmpnr 

Presenter: Lois A. Monteiro. Ph.D. Title: rhpirripn^ Department of Community H ea] 

Affiliation: Brown University Telephone: (■ ^ \ 863-1629/31 72 faX: ( ) 863. 3713 

(Medical School/Res(der>cv Program) 

Department of Community Health mmo 

Address: 97 WPit-Prr^an ^rT,^>=t Box G-AA yy^^r-^^^^n,. . rt \l±Zl£ . 

City Zip Code 

Completing the Abstract Submission Form [ 

• All text should be typed within the perimeters of the box shown. Fonts no smaller than \0 points should be used. 
■ Orgar^ze the text of the abstract as follows; (1) objectives of the curriculum; 12) curhculum descnption; 

(3l problems encountered; er*d (4) resirtts. 



A prepared faculty interested in women's health issues is central to the 
establishment of a women's health curriculum. At Brown we have focused on 
developing collaboration between women faculty on research topics and on 
patient care. Since an infrastructure of support for women faculty, many of 
whom are at the Assistant Professor rank, is essential to developing these 
faculty, we have established an Office of Women in Medicine, have appointed an 
Associate Dean of Women, and have a women in medicine faculty committee. 
These offices cooperated with the Associate Dean for Faculty Affairs to present 
a faculty development conference for women faculty that centered on teaching, 
research, and career issues for women faculty. A group of women faculty 
successfully prepared an application as a Vanguard Center for the Women's 
Health Initiative (N.I.H.). A university grant has been awarded to a group of ten 
women Medical School faculty to support a faculty study group in the 1995- 
1996 academic year to examine education on women's health in the medical 
school core curriculum and to consider ways, such as a university center, to 
formalize these interests within the structure of the university. The group will 
review topics related to specific diseases, e.g., women and heart disease, 
women and AIDS, reproductive health. Secondly, they will discuss topics that 
cross diseases and relate to gender issues in women's access to health care, 
such as the health of women of color: older women as patients; concerns about 
the shortened length of hospital stay after delivery; the care for high risk 
participants in prenatal care; and health insurance. Thirdly, they will consider 
topics related to women and the health care delivery system. The end product 
of the study group's activity will include a plan for a university center on 
women's health research and strategies for integration of women's health 
topics into the curriculum. 



Address submissions to: Elena Rios, M.D , W.S P M. Telephone. (202) 690-5884 

Office on Women's Health. OASM FAX. (202) 690-7172 

200 Independence Ave.. N W.. Room 730-8 
Washington, O.c: 20201 

DEADLINE FOR SUBMISSION: Friday, August 4, 1995 



92 



I J ; CULTURAL CCMp£TENCS AND WOMEM'S HEALTH CURRICULA IN WEDICAL EDUCATION 

n ABSTRACT SUBMISSION FORM 

Abstract TirJe: ■■ Bociocultural Aspects of Women's Health In Under sa-^idua-fce Medical EdiirR-h-i nn 
J-, -Ana E. Nunez, MD and iissistant Dean of GeneraJism & the Coaanunity 
' Ire.'ieiner: Helen Li. Coons, Ph.D. Tixie: Clinical Assistant Professor 

Medical Colllege of Pennsylvania & (215) ^62-T6i6 (215) 762-863k 

Affiliation: Hahnenwmi Uttlver^itv Telephone: ( '■ ) - FAX: ( ) 

« f :(Meoicai ScModl/Residencv ProgramJ 



Address: Broad and Vane Streets MS kkO, Philadelphia, PA 19102-1192 

: City Zip Code 

ornpteting the Abitract Submission Form 
• • All text shouid Se ryoed wittiin tne oenm^ters of the box shOv*n. ?cnts no amaller than 10 points should be used. 

Organize the text o^ the abstract as follows: (1) objectives of CT^e curriculum; (2) curriculum descricJtion: 

:2] pioLIsms encounTftfsd: land 1^; i©4u«t5. 



Ij 



m 



'[ 



(1) OBJECTIVE OF THE CURRICULUM 

A. Increased knowledge of gender and ethnic-based differences which affect women's experiences in the health setting. 
, B. Increased icnowiedg|j of women's health and mental health concerns frequently overlooked in the clinical encounter. 

C. Increased kno^ledgt of sociodemographic factors associated with risJt for health and mental health problems among 
wornen. ! ; | 

; D. Incrjiased knowled^ of siraregies to promote optimal health and mental health outcomes with ethnically diverse women 
! acroiss the life span, j \\\ 
I E. Role model multidistlpUnary collaboradon in teaching and care. 

(2) CURRICULUM TE^CRIPTION 

I A. Content ! ||i B. Tg89hinr ^tn«gnff:> 

I • Biopsychosocial apjjrpjLch to women's health and mental ' Large group didactic with raulticultural, 

i health. i I ; ' multidisciplinary teaching team. Team consists of a 

• Diversity among wolmeti (i.e., ethnicity, S.E.S., age, religion, general internist and clinical psychologist. 

I education, relationship sutus, sexual orientation, etc.) * Video analysis of women coping with health 
I • Gender and cultural idlfferences in communication style: problems to illustrate the social, cultural, and 

! Impact on the physitan-patient relationship. relational coniexx of women's lives. 

• Within and across esinlc and ^e group diversity. • Multicultural, multidisciplinary panel discussion with 
[ • Impact of violence on women's health and health care a general internist, clinical psychologist, ob/gyn and 

1 _ utiiiaation, — i ! i ■ physician's assistant 

• Risk factors lor ueptession and stJsstance abuse in women. ' Bibliography on biomedical, sociocultural, and 

• Health and mental health concerns frequently overlooked in psychosocial aspects of women's healih. 
j the clinical encountirl! I 

•IdcnnfT-:- -"H of women at risk for health and mental health C. Evaluation Strategy 
! probit, j 1 1 1 • Pre- and post-test of knowledge women's health. 

j • Pron Hiag :ptiraal health outcomes in diverse women across 
! the life span. I ■ ! ; 

(3) PROBiLEMS ENCO0NTEREI> 

Overcwning reltvanceito istudent who are focused on basic science in pre-clincal years, 
j Large group format (l60'^tudents) precluded optimal interactions about complex sociocultural issues. 

(4)RESULTS^ jiil ; 

Feedback indicated increased knowledge of: 1) epidemiology of women's health problems; 2) gender, ethnic and S.E.S. 
bias in; access to, utilizktion, and quality of health care; 3) social, ethnic, and relanonal factors affectmg women's health and 
health behavior; 4) strategies to provide gender and culture specific care; 5) need for more small group case discussions. 



-lirt -••^ •ai:brT)tss.cn:; ro; Eiena Rics. M . M.S.?.H. Telechone: (2025 690-5S8-i 

i Office on V.'cmen's HesU^.. OASH FAX. (202> 690-7 1 72 

\ 20C IniiepencJonce Ave.. i*-I.W.. Room 730-3 

1 Wasnincton. O.C. 20201 



,1 



•DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30, 1995 

93 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION PORM 

Abstract Title: ^^^^^^^"8 Health Concerns of Arab and Muslim Women 

Kach-irine Sherif, MD ^. Ascicra-nr P-r/^fac^^^ 
Presenter; \ TitlQ: ^^^iscant Professor 

Affiliation: Mrp^.r Telephone: (213842 - 7390 FAX: (^9) *k^S- ertSI 

(Medical School/Rtsidency Program) 

Institute for Women's Health 

Address: 3300 Henry Ave. Ph^ T ^r^«.iph-f o pa ^9^^9 

City Zip Code 

Completing the Abstract Submission Form 

■ All text ihouJd b« typad within the perimetars of th« box ihown. Fonts no smaller than 10 points should b« uaed. 

■ Organize the text of the abstract as follows; (1) objectives of the cunicuium; (2) cum'culum description; 
■ 3? proUgm^ ADcoorit^ret^: and t-; leiiMti. 



OBXECTTVE: To improve the health care of Arab and Moslem women by teaching 
health care providers about their unique health concerns. 

CURRICULUM DESCRIPTION: Islam is one of the most widely practiced religions 
in the world, with large concentrations of Moslems in Asia, Africa and the Middle East. In 
the past decade, a large number of Moslems have immigrated to the United States. Arab 
women arc also immigrating in large numbers and although they are not all Moslems, they 
share some of the same health concerns as Moslem women because of widespread cultural 
influence?. The demand by these women to see Moslem and Arabic practitioners is 
overwhelming. The health issues that Moslem women face are unique and influenced by 
religious morals and cultural constructs to a large extent. Health care practitioners will 
eventually sc^e larger numbers of Moslem women and will need to be aware of their health 
concerns in order to provide excellent care. The health concerns among Arab and Moslem 
women are not monolithic among the dozens of subcultures and regions but many elements 
arc shared. While many of the health concerns they face are similar to American women, 
others are very different. The concerns range from religious and cultural attitudes about the 
body and about taking medication to the relationship with the health care provider to issues 
such as female genital mutilation. 

PROBLEMS ENCOUNTERED: Many Arab and Moslem women will not seek health 
care if they cannot see an Arab or Moslem female practitioner because they fear 
mistreatment and misunderstanding. 

RESULTS: Health care practitioners wUl be able to provide excellent health care to Arab 
and Moslem women by gaining an understanding of some of the unique health concerns of 
this group. 




.Vdflrn'5 submissions to: Ciena Rios. M.O.. M.S.P.H. Telephone: <202) 690-5884 

0»f.c« on Womeni Heaiih. QASH FAX: (2C2) 690-7172 

200 Indeoendence Ave.. N W.. Room 730-8 
Washington. O.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30. 1995 



94 



CULTURAL COMPETENCE AND WOMEN'S HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FORM 

Abstract Title: nijltnr=l nnmn° f,ence and Previsions of LJamen's Health in American Indian 
CommunitiBa. - 

-, Presents.-: Lois G.F. Steals, M.D. Tiiit: Regeerch Medical Qfficsr, Indian H ealth 

Affiliation; iinix/Pr^ity nf A7 .Srhnnl nf Telephone: (H?n^ 2qg>?L7q FAX: 620 291-260? 

Medicine (Medical Scnooi/Heaidancv Program) 

Addrssa: 7900 South J. Stock Road Tucson, A2 85746 

City Zip Code 

Completing the Abstract Submission Fcmi 

• All laxt s.taulo C3« tvpea within tns D»nnmars of th« box shown. Ponta no •malUr than 10 poinw should ba uaad. 
■ Organize tha taxt of tha ibatract 99 follows: (11 objactjvea of tfje curriculum; I2J curriculum dttcriptjon; 
<3} Dfobiams ancounrsfed: and (4) raauits. 

CULTURAL COMPETENCE ANT PROVISION OF WOMEN ^ B HEALTH 
IN AMERICAN INDIAN COMMUNITIES 

Efforts have been aadm the past twenty five yeura to recruit 
qualified under represented minority atudanta Into health career 
training . Some medical schools Jiave been leaders In these 
efforts and have noted the discrepancies In diseases In their 
etatea betv^en rich and poor, various ethnic groupa and the 
majority population. At the aame time medical research haa 
focused on males. Females health problems are finally being 
studied. Barriers to care are being explored. The rolea a till 
are aeen as "rescuer" and "tmfortunate" or "patient. " This must 
change if a meaningful, productive relatlonahlp la to ooour that 
will briny the health of minority women to the level of the rest 
of the nation. 

This paper dlacuaaea inter -cultural aensitlvity to American 
Indian vouem. The empowerment of theae women enables a provider 
to^ practice medicine so that an effective, efficient visit occurs 
that is mutually satisfying. Child rearing, breast feeding, and 
ways of jommunicatlon are discussed. Sexual folkways and morea 
and their effects on medical care are described for several 
tribes. Some of theae materials were Incorporated Into lecturea 
Bt the University of North Dakota, ten years ago. Other 
materials have been accumulated from new work with southwmstem 
peoples. 

Strategies for permanently Incorporating cultural competence and 
women's health curricula within medical education will have a 
lasting effect when people with the skill to do so, join the 
ranks of tenured faculty. It may take twenty five more years of 
effort for this to occur. 



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M.1iji-«<?? Sv-=r-:ssicn« co: Elana Rms. M.O . M.S.P.M Teleohon«: (202) 830-5884 

Office en Women 1 Heattn. OASH FAX: (202) 390-7172 

200 inOioand«ncs Ava.. N.W., Room 73C-3 
Washinscon, O.C. 20201 

DEADLINE FOR SUBMISSION: FRIDAY, JUNE 30. 1995 

95 



CULTURAL COMPETENCE AMD WOME.N'? HEALTH CURRICULA IN MEDICAL EDUCATION 

ABSTRACT SUBMISSION FUHM 

AbStrac: Title: T r^ininr; Residents Jn Vlulance Prevent, inn and Ciil i nr^il r.nn^p^r^-,.,-r. 

Q .,*.*,. Jchr. Takayama, M.D.. M.P. H. Title: Assistant Professor 

j,^r^y,^,,an: UC Snn FrancL^co telephone: f'^^ ^^^.-5763 p.^^: iiilJI^-__8130_ 

(Melic.i( Ssriooi/fiosiaencv rreo''*'"' 

AOn Pai-nassub Avenue Ace i^uilding 2nd floor HooTr a2U6a CA 9A.143 

Address: _________———_— — . — - ^ — -— r — ^ , 

City Zip Code 

Compiexing the Abstract Submission Porm 

■ All lex; 4hou*d b« tvped wanin The per.motafs 5f th« box ahown. Fonts no >m/iller ihan 10 point! ihoutd be uied. 
e Orginlie th« t«xi of the aoatrtct js toUows: ID obiftCti««8 of the cumculum; (2) curriculum descrtpiion; 
(3) pfoblems ftpcountefod; and (41 rt suita. __,,,,,^_^_„„^,,...„.__i.«««.«=^== 



Problems Uiat affect tlie community, such as the cunenl epidemic of violence, pose special 
challenges fv)r primary care physicians predominantly trained in hospital settings. We developed a 
one-month rotation in community health for second and ihini year pediatric residents at the 
University of California San Francisco. In 1994-5, nine residents participated in this rotation, 
which featured seminar discussions and field experiences. We report on the educational 
component that addressed violence prevention and cultural competency. 1 . Violence Prevention : 
Invited community professionals and advocates led group discussions on the impact of violence in 
families and recognizing child abu.se and domestic violence. We used videotapes of critical 
incidents and rcle play among residents to practice skills in discussing child rearing issues, e.g., 
discipline and conflict resolution, and asking about violence and making appropriate referrals. 
Residents gained field experience by promoting violence prevention in schools and leading 
discussion groups in shelters for victims of violence. 2. Cultural Competence : The diversity of 
San Francisco's population provides an opportunity for physicians to practice cross-cultural 
communication. Residents were introduced to cultural competency tlirough a seminar to cxploix? 
their own bie^es and discussions on ethnic diversity and the effective u.se of interpreters. During a 
major proportion of the rotation, residents provided health care at facilities recognized by the 
community for culturally appropriate health services. On-site professionals in healtli, nudition and 
social woiic guided residents in developing culture-specific communication skills. Problems 
encountered duiir.;; this rotation included the variable abilities of community preceptors and tlie 
inordinate eftort required to administer the program. Suivey evaluation before and after the 
rotation demonsurated positive changes in attitudes und comfort regarding violence prevention and 
cultural competence. We plan to analyze videotaped office visits to detennine the impact of tliis 
intervention on resident beiiavior. We believe tliat residency training must include the community 
to effectively prepare physicians to address community healtli issues. 



aL Ki rt kyi R P u Teleohono: -'202) 690.9Ba« 

artnf«-l ^uomioiun^ to: CFj«na «(o8. M.O., M.5.P.H "w eeO-717a 

QfTico on Wom«n'» Healt". Oash PAX: '■^'•>^' "»" 

200 inaooenaenca Av«.. N.W.. Room ''30-B 
Wasnin^ton, O.C 20201 

DEADLINE FOR SUBMISSION: FRIDAY. JUNE 30. 1995 



96 



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Health Resources and Services Administration 

Bureau of Health Professions 
Division of Medicine 



MISSION 
The Division of medicine is ttie aclcnowledged Federal resource wiiicii monitors and assures the optimal 
supply, specialty mix, demographic composition demographic distribution of competent physicians, 
physician assistants and other providers to meet the public's health care needs. 

STRATEGIC DIRECTIONS 

1. Promote Generalism: Promote generalism and improve the education of allopathic and osteopathic family 
physicians, general internists, general pediatricians, and primary care physician assistants. 

2. Promote Workforce Diversity: Promote strategies to attain a physician, physician assistant, and health care 
workforce profile that more closely represents the composition of minorities, women, and socioeconomically 
disadvantaged in the general population. 

3. Promote Strategies to Improve Care for the Underserved: Promote educational strategies to recruit and retain 
more well-trained providers for the rural and urban underserved. 

4. Improve Primary Care Quality: Improve the quality of primary care through educational strategies that develop 
and maintain clinical competence, in such priority areas as HIV disease, substance abuse, and clinical preventive 
services. 

5. increase Primary, Care Teaching and Research Capacity: Increase the number and quality of primary care faculty 
and researchers, particularly from community-based settings. 

6. Improve Preparation for Managed Care Practice: Promote educational strategies that equip health professionals 
with the knowledge, attitudes and skills needed for managed care practice. 

7. Emphasize Public Health and Interdisciplinary Training: Emphasize public health and interdisciplinary approaches 
to education and practice. 

8. Strengthen Surveillance, Research and Evaluation: Strengthen physician and physician assistant workforce 
surveillance, trend analysis, and educational research, and Division-wide program evaluation. 

9. Provide Leadership: In partnership with health professions schools, states and communities, provide leadership 
through policy development, innovative programming, enhanced communication, and scholarly excellence to attain 
our mission. 

1 0. Participate in International Medical Education: Support and participate in global efforts to make medical practice 
and education more responsive to people's needs. 

Enrique S. Fernandez, IVI.D., M.S.Ed. 

BHPr, Director, Division of Medicine 

5600 Fishers Lane, Room 9A-25 

Rockville, Maryland 20857 

(301) 443-6190 

(301) 443-8890 (FAX) 



Elsie Quinones, M.A. 

Program Specialist, Division of Medicine 

Primary Care Medical Education Branch 

(301) 443-1467 



Office on Women's Health 

U.S. Public Health Service 

Office of the Secretary 

U.S. Department of Health and Human Services 

Hubert H. Humphrey Building 

200 Independence Avenue, S.W. 

Room 7-30 B 

Washington, D.C. 20201 



Telephone: 
FAX: 



(202) 690-7650 
(202) 690-7172 



CONTACT: Elena Rios, M.D. 



Office of Minority Health 

Public Health Service 

Office of the Secretary 

U.S. Department of Health and Human Services 

5515 Security Lane, 10th Floor 

Rockwall II Building 

c/o 5600 Fishers Lane 

Rockville, Maryland 20857 



Telephone: 
FAX: 



(301) 443-5084 
(301) 594-0767 



CONTACT: Guadalupe Pacheco, M.S.W.